WELLSTAR MEDICAL GROUP LLC NPI 1558664003

NPI Information

  • NPI: 1558664003
  • Provider Name: WELLSTAR MEDICAL GROUP, LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: WELLSTAR FAMILY MEDICINE ACW
  • CLIA Number: 11D0997387
  • Address: 5150 STILESBORO RD NW
    SUITE 120
    KENNESAW, GA
    ZIP 30152
  • Phone: (678) 354-0230

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NPI Details

WELLSTAR MEDICAL GROUP, LLC is a family medicine in Kennesaw, GA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. WELLSTAR MEDICAL GROUP, LLC NPI is 1558664003. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Wellstar Family Medicine Acw.

The provider's business location address is:

5150 STILESBORO RD NW
SUITE 120
KENNESAW, GA
ZIP 30152-744
Phone: (678) 354-0230
Fax: (678) 354-0828

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 11D0997387 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/6/2010 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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineGEORGIAYes

What is NPI?

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This page was last updated on: 3/30/2025

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