Organization Active NPI

West Georgia Obstetrics & Gynecology P.C.

  • Obstetrics & Gynecology Physician
  • Carrollton, GA
National Provider Identifier
1114075694
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
WEST GEORGIA OBSTETRICS & GYNECOLOGY P.C.
Practice address
109 Professional PL
Carrollton, GA 30117-3862
Phone
(770) 834-0170
Fax
(770) 214-1456
NPI assigned
Jan 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Denise M. Murrah
Title
Office Administrator
Phone
(770) 834-0170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

109 Professional PL
Carrollton, GA 30117-3862

Mailing address

109 Professional PL
Carrollton, GA 30117-3862
Phone (770) 834-0170

Other identifiers 2

IdentifierTypeStateIssuer
00223253AMedicaidGA
00824051AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040102000305 GA Part B Supplier - Clinic/Group Practice 2062311632 Receives reassigned benefits from 3 practitioners
Practice locations: Carrollton, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114075694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 PROFESSIONAL PL",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173862",
            "telephone_number": "770-834-0170",
            "fax_number": "770-214-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 PROFESSIONAL PL",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173862",
            "telephone_number": "770-834-0170",
            "fax_number": "770-214-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GEORGIA OBSTETRICS & GYNECOLOGY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MURRAH",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-834-0170",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00223253A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00824051A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.