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WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES LLC NPI 1083660682


NPI Information

NPI: 1083660682
Provider Name: WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES, LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D0705825

Address:
1371 CHURCH STREET EXT NE
MARIETTA, GA
ZIP 30060
Phone: (770) 422-8315
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WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES, LLC is a pediatrics in Marietta, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES, LLC NPI is 1083660682. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1371 CHURCH STREET EXT NE
MARIETTA, GA
ZIP 30060-913
Phone: (770) 422-8315
Fax: (770) 590-9170

The provider's authorized official is Nicole Ashe .
The authorized official title is Executive Director Of Finance and has the following contact phone number (770) 792-5261.

The CLIA number assigned to this NPI record is 11D0705825 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/25/2006 and was last updated on 7/14/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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