Provider Demographics
NPI:1245940782
Name:WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC
Entity type:Organization
Organization Name:WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-884-7301
Mailing Address - Street 1:519 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-9635
Mailing Address - Country:US
Mailing Address - Phone:706-845-4898
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:30241-2338
Practice Address - Country:US
Practice Address - Phone:706-845-4898
Practice Address - Fax:706-845-0687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST GEORGIA HOME MEDICAL EQUIPMENT CO INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00029455AMedicaid
GA1111171OtherNCPDP