Provider Demographics
NPI:1356073001
Name:WEST COLLECTION
Entity Type:Organization
Organization Name:WEST COLLECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-305-2151
Mailing Address - Street 1:3047 ALFRED DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-4903
Mailing Address - Country:US
Mailing Address - Phone:478-305-2151
Mailing Address - Fax:
Practice Address - Street 1:3047 ALFRED DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4903
Practice Address - Country:US
Practice Address - Phone:478-305-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory