WEST ATLANTA PRIMARY CARE
NPI 1629724752
Clinic/Center - Primary Care in Douglasville, GA
About West Atlanta Primary Care NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WEST ATLANTA PRIMARY CARE (NPI 1629724752) is a healthcare organization registered as a primary care in Douglasville, Georgia and active in the NPI registry since February 2022. The organization holds a CLIA Waiver certificate valid through August 2, 2028 and lists Shivam Desai, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
West Atlanta Primary Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to West Atlanta Primary Care, which bills Medicare for the services this clinician delivers.
Clinician (1)
Douglasville, GA 30135
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 11D2265870
West Atlanta Primary Care · Douglasville, GAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is West Atlanta Primary Care's NPI number?
The NPI number for West Atlanta Primary Care is 1629724752. It was assigned to this organization in the NPPES registry on February 28, 2022.
Where is West Atlanta Primary Care located?
West Atlanta Primary Care is located at 4904 Timber Ridge Dr Ste 102, Douglasville, GA 30135. The listed phone number is (678) 521-0935.
What is West Atlanta Primary Care's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is West Atlanta Primary Care enrolled in Medicare?
Yes. West Atlanta Primary Care is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through West Atlanta Primary Care?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to West Atlanta Primary Care. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does West Atlanta Primary Care hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2265870) is associated with this NPI, valid through August 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for West Atlanta Primary Care was last updated on March 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# West Atlanta Primary Care · NPI 1629724752
Primary Care organization in Douglasville, Georgia. Organization record, active in the CMS NPPES registry since February 28, 2022.
## Identity
- **NPI:** 1629724752 (Entity type: Organization)
- **Enumerated:** February 28, 2022
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Shivam Desai, OWNER
## Practice location
- **Address:** 4904 TIMBER RIDGE DR STE 102, Douglasville, GA 30135-1831
- **Phone:** (678) 521-0935
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 25, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1629724752) · Data from the CMS NPPES public registry.