NPIMap

Organization Active NPI

West Georgia Urology Associates PC

  • Urology Physician
  • Carrollton, GA
National Provider Identifier
1982701124
Registry record updated Jan 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
WEST GEORGIA UROLOGY ASSOCIATES PC
Practice address
150 Clinic Ave
Suite 202
Carrollton, GA 30117-4402
Phone
(770) 834-6988
Fax
(770) 834-1090
NPI assigned
Sep 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2013

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

Authorized official

Name
Mr. Marc Morin
Title
Office Manager
Phone
(770) 834-6988

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

150 Clinic Ave
Suite 202
Carrollton, GA 30117-4402

Mailing address

150 Clinic Ave
Ste 202
Carrollton, GA 30117-4402
Phone (770) 834-6988

Other identifiers 1

IdentifierTypeStateIssuer
0438940001OtherGAPALMETTO GBA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040226000310 GA Part B Supplier - Clinic/Group Practice 6608762521 Receives reassigned benefits from 9 practitioners
Practice locations: Carrollton, GA; Villa Rica, GA
O20130701000270 AL Part B Supplier - Clinic/Group Practice 6608762521 Receives reassigned benefits from 1 practitioner
Practice locations: Wedowee, AL

National Provider Directory

National Provider Directory

Locations

200 Allen Memorial Dr
Ste 202
Bremen, GA 30110
Phone (770) 830-8944

Practitioners & affiliated clinicians

Practitioners 10

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358121600000",
    "number": "1982701124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE",
            "address_2": "STE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174402",
            "telephone_number": "770-834-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 CLINIC AVE",
            "address_2": "SUITE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174402",
            "telephone_number": "770-834-6988",
            "fax_number": "770-834-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST GEORGIA UROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-01-14",
        "status": "A",
        "authorized_official_last_name": "MORIN",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-834-6988",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "0438940001",
            "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 Jan 14, 2013; 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.