Provider Demographics
NPI:1922103621
Name:NEUROLOGY CENTER OF WEST GEORGIA PC
Entity Type:Organization
Organization Name:NEUROLOGY CENTER OF WEST GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALLENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-884-3018
Mailing Address - Street 1:300 MEDICAL DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4130
Mailing Address - Country:US
Mailing Address - Phone:706-884-3018
Mailing Address - Fax:706-884-3060
Practice Address - Street 1:300 MEDICAL DR
Practice Address - Street 2:SUITE 700
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4130
Practice Address - Country:US
Practice Address - Phone:706-884-3018
Practice Address - Fax:706-884-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3516Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER