Provider Demographics
NPI:1043318355
Name:LAGRANGE MED CENTER, LLC
Entity Type:Organization
Organization Name:LAGRANGE MED CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:SOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-885-9110
Mailing Address - Street 1:309 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3162
Mailing Address - Country:US
Mailing Address - Phone:706-885-9110
Mailing Address - Fax:706-885-9113
Practice Address - Street 1:309 VERNON ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3162
Practice Address - Country:US
Practice Address - Phone:706-885-9110
Practice Address - Fax:706-885-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty