Provider Demographics
NPI:1306938550
Name:WEST GEORGIA ENDOSCOPY CENTER
Entity type:Organization
Organization Name:WEST GEORGIA ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-214-2800
Mailing Address - Street 1:160 CLINIC AVE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4451
Mailing Address - Country:US
Mailing Address - Phone:770-214-2800
Mailing Address - Fax:770-834-3321
Practice Address - Street 1:160 CLINIC AVE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4451
Practice Address - Country:US
Practice Address - Phone:770-214-2800
Practice Address - Fax:770-834-3321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022307261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA387698079AMedicaid
GAP00269425OtherRAILROAD MEDICARE
GA111259ASCAMedicare PIN