University of West Georgia

NPI #1235528811 in Carrollton, Georgia

Provider Information

NPI Number: 1235528811
Entity Type: Organization
Organization Name: University of West Georgia
Primary Specialty: Family Medicine
Enumeration Date: Jan 20, 2015
Last Updated: Jan 20, 2015

Practice Location

Address: 1601 MAPLE ST
City: Carrollton
State: Georgia
ZIP Code: 30118-0001
Phone: (678) 839-6628

Authorized Official

Name: MOUZON BASS III
Title: AGENT
Phone: 18005559073

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine - Sports Medicine — Sports Medicine	207QS0010X
Family Medicine	207Q00000X	Primary

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