Provider Demographics
NPI:1326553090
Name:WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC
Entity type:Organization
Organization Name:WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-350-4200
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-0017
Mailing Address - Country:US
Mailing Address - Phone:706-350-4200
Mailing Address - Fax:706-350-4220
Practice Address - Street 1:1861 ROANOKE RD STE A
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3850
Practice Address - Country:US
Practice Address - Phone:706-350-4200
Practice Address - Fax:706-350-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0104023336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003199976AMedicaid