Provider Demographics
NPI:1053689273
Name:ATLANTA WEST PRIMARY CARE ASSOCIATES PC
Entity Type:Organization
Organization Name:ATLANTA WEST PRIMARY CARE ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-948-5400
Mailing Address - Street 1:939 THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2634
Mailing Address - Country:US
Mailing Address - Phone:770-948-5400
Mailing Address - Fax:770-948-4930
Practice Address - Street 1:939 THORNTON ROAD
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2634
Practice Address - Country:US
Practice Address - Phone:770-948-5400
Practice Address - Fax:770-948-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA28114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty