Provider Demographics
NPI:1376557678
Name:WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC
Entity Type:Organization
Organization Name:WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC
Other - Org Name:HOLMES PHARMACY
Other - Org Type:Doing Business As
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:706-884-7301
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:706-884-7301
Mailing Address - Fax:706-845-0687
Practice Address - Street 1:136 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-2338
Practice Address - Country:US
Practice Address - Phone:706-884-7301
Practice Address - Fax:706-845-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X
GAPHRE0058353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012467OtherPK
GA000029455BMedicaid
GA000029455AMedicaid
GA000029455BMedicaid