Provider Demographics
NPI:1811993041
Name:WEST, JANICE L (PA)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:L
Last Name:WEST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:L
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:STE 300
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8116
Mailing Address - Country:US
Mailing Address - Phone:770-944-2830
Mailing Address - Fax:678-581-7170
Practice Address - Street 1:1020 J L WHITE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4908
Practice Address - Country:US
Practice Address - Phone:706-692-0603
Practice Address - Fax:678-581-7109
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003557363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1811993041OtherNPI