Provider Demographics
NPI:1821734856
Name:WEST, DEREK A
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:A
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WINDSOR WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6446
Mailing Address - Country:US
Mailing Address - Phone:404-786-8598
Mailing Address - Fax:
Practice Address - Street 1:500 WINDSOR WAY
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-6446
Practice Address - Country:US
Practice Address - Phone:404-786-8598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP011562163W00000X, 372600000X, 163WA2000X, 163WH0200X, 163WP0200X, 163WW0000X, 172A00000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No163W00000XNursing Service ProvidersRegistered Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No172A00000XOther Service ProvidersDriver
No374U00000XNursing Service Related ProvidersHome Health Aide