Provider Demographics
NPI:1306319256
Name:WEST GEORGIA HEALTHCARE
Entity type:Organization
Organization Name:WEST GEORGIA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIELCARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-462-4402
Mailing Address - Street 1:210 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3738
Mailing Address - Country:US
Mailing Address - Phone:770-834-1898
Mailing Address - Fax:770-834-4814
Practice Address - Street 1:210 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3738
Practice Address - Country:US
Practice Address - Phone:770-834-1898
Practice Address - Fax:770-834-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty