NPIMap

Organization Active NPI

Carroll County Neurology

Doing business as West Georgia Sleep Disorders and Neurology Associates

  • Neurology Physician
  • Carrollton, GA
National Provider Identifier
1407916455
Registry record updated Dec 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
053520 Issued in GA
Legal business name
CARROLL COUNTY NEUROLOGY
Doing business as
West Georgia Sleep Disorders and Neurology Associates
Practice address
524 Dixie St
Carrollton, GA 30117-3805
Phone
(770) 832-2775
Fax
(770) 832-9529
NPI assigned
Dec 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2009

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

Authorized official

Name
Mrs. Rebecca Lee Walker
Title
Administrator
Phone
(770) 832-2775

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X 040159 GA
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X 050478 GA
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X 053520 GA Primary

Addresses

Primary practice location

524 Dixie St
Carrollton, GA 30117-3805

Mailing address

524 Dixie St
Carrollton, GA 30117-3805
Phone (770) 832-2775

Other identifiers 23

IdentifierTypeStateIssuer
130011906OtherR X R MEDICARE
13BDDKV01OtherMEDICARE ID
000920796BMedicaidGA
009981360MedicaidAL
130024279OtherR X R MEDICARE
009602420MedicaidAL
13BDDKVOtherMEDICARE
52212528OtherBCBS
864345OtherBCBS
000670909EMedicaidGA
13BDCK01OtherMEDICARE ID
13BDCKSOtherMEDICARE ID
506390OtherBSBC
586993320EMedicaidGA
000920796AMedicaidGA
5632868OtherCIGNA
000920796CMedicaidGA
13BDFFB01OtherMEDICARE ID
6941783OtherCIGNA
7357225OtherAETNA
000670909AMedicaidGA
000670909FMedicaidGA
13BDFFBOtherMEDICARE ID

Other names 1

  • West Georgia Sleep Disorders and Neurology Associates Doing business as

National Provider Directory

National Provider Directory

Locations

524 Dixie St
Carrollton, GA 30117
Phone (770) 832-2775

6043 Prestley Mill Rd
Ste 3
Douglasville, GA 30134

19 Eastbrook Bnd
Ste 200
Peachtree Cty, GA 30269
Phone (678) 833-5199

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259798400000",
    "number": "1407916455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173805",
            "telephone_number": "770-832-2775",
            "fax_number": "770-832-9529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173805",
            "telephone_number": "770-832-2775",
            "fax_number": "770-832-9529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARROLL COUNTY NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2009-12-03",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "770-832-2775",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "040159",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "050478",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "GA",
            "license": "053520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R X R MEDICARE",
            "identifier": "130011906",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "13BDDKV01",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000920796B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009981360",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R X R MEDICARE",
            "identifier": "130024279",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009602420",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "13BDDKV",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52212528",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "864345",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000670909E",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "13BDCK01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "13BDCKS",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSBC",
            "identifier": "506390",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "586993320E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000920796A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5632868",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000920796C",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "13BDFFB01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6941783",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7357225",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000670909A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000670909F",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "13BDFFB",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Georgia Sleep Disorders and Neurology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.