Basic Information
| Provider Information | |||||||||
| NPI: | 1467405712 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J MICHAEL WEST MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 PRINCE AVE | ||||||||
| Address2: | STE 1B | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065480008 | ||||||||
| FaxNumber: | 7063699673 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 PRINCE AVE | ||||||||
| Address2: | STE 1B | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065480008 | ||||||||
| FaxNumber: | 7063699673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | LINDQUIST | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7065480008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 020621 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 00181112A | 05 | GA | MEDICAID |