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WELLSTAR MEDICAL GROUP LLC NPI 1336445485


NPI Information

NPI: 1336445485
Provider Name: WELLSTAR MEDICAL GROUP, LLC

Doing Business As: WELLSTAR PEDIATRIC PROFESSIONALS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D1017915

Address:
1880 W OAK PKWY
SUITE 101
MARIETTA, GA
ZIP 30062
Phone: (770) 795-8783
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WELLSTAR MEDICAL GROUP, 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 MEDICAL GROUP, LLC NPI is 1336445485. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Wellstar Pediatric Professionals.

The provider's business location address is:

1880 W OAK PKWY
SUITE 101
MARIETTA, GA
ZIP 30062-272
Phone: (770) 795-8783
Fax: (770) 795-7424

The provider's authorized official is Nicole Ashe .
The authorized official title is Executive Director Of Finance and has the following contact phone number (470) 644-0095.

The CLIA number assigned to this NPI record is 11D1017915 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/8/2011 and was last updated on 11/19/2013.


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
1208000000XPediatricsGEORGIAYes

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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