Provider Demographics
NPI:1689985954
Name:WEST GEORGIA MEDICAL CENTER INC
Entity Type:Organization
Organization Name:WEST GEORGIA MEDICAL CENTER INC
Other - Org Name:WEST GEORGIA HEALTH MICHAEL D MYERS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-644-0012
Mailing Address - Street 1:1800 PARKWAY PL SE STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8237
Mailing Address - Country:US
Mailing Address - Phone:470-956-4981
Mailing Address - Fax:770-999-2489
Practice Address - Street 1:303 MEDICAL DR
Practice Address - Street 2:STE 406
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4169
Practice Address - Country:US
Practice Address - Phone:706-242-5201
Practice Address - Fax:706-242-5204
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST GEORGIA MEDICAL CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-01
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64613208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty