Provider Demographics
NPI:1356689806
Name:WEST ATLANTA INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:WEST ATLANTA INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-942-6903
Mailing Address - Street 1:6128 PRESTLEY MILL RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5621
Mailing Address - Country:US
Mailing Address - Phone:770-942-6903
Mailing Address - Fax:770-942-6908
Practice Address - Street 1:6128 PRESTLEY MILL RD
Practice Address - Street 2:SUITE G
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5621
Practice Address - Country:US
Practice Address - Phone:770-942-6903
Practice Address - Fax:770-942-6908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046866261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH28136Medicare UPIN