Provider Demographics
NPI:1902183205
Name:INTERNAL MEDICINE ASSOCIATES OF WEST ATLANTA, P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF WEST ATLANTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DONELL
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-739-2440
Mailing Address - Street 1:939 BOB ARNOLD BLVD
Mailing Address - Street 2:STE F
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3258
Mailing Address - Country:US
Mailing Address - Phone:770-739-2440
Mailing Address - Fax:770-819-8808
Practice Address - Street 1:939 BOB ARNOLD BLVD
Practice Address - Street 2:STE F
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3258
Practice Address - Country:US
Practice Address - Phone:770-739-2440
Practice Address - Fax:770-819-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty