WELLSTAR CARDIOVASCULAR MEDICINE LLC NPI 1770868531

NPI Information

NPI: 1770868531
Provider Name: WELLSTAR CARDIOVASCULAR MEDICINE, LLC
Classification: Internal Medicine - 207RC0000X
Entity Type: Organization

Specialization: Cardiovascular Disease

CLIA Number: 11D0255127

Address:
4900 IVEY RD NW
BLDG 1800 SUITE 1801
ACWORTH, GA
ZIP 30101
Phone: (770) 974-8479
Get Directions

WELLSTAR CARDIOVASCULAR MEDICINE, LLC is a cardiovascular disease internal medicine in Acworth, GA. The provider is an internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. WELLSTAR CARDIOVASCULAR MEDICINE, LLC NPI is 1770868531. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4900 IVEY RD NW
BLDG 1800 SUITE 1801
ACWORTH, GA
ZIP 30101-001
Phone: (770) 974-8479
Fax: (770) 974-8710

The provider's authorized official is Barry D Mangel .
The authorized official title is Chief Cardiology Officer and has the following contact phone number (770) 424-6893.

The CLIA number assigned to this NPI record is 11D0255127 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/12/2011 and was last updated on 5/9/2012.

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	Primary
1	207RC0001X	Internal Medicine	Clinical Cardiac Electrophysiology	No
2	207RI0011X	Internal Medicine	Interventional Cardiology	No
3	207RC0000X	Internal Medicine	Cardiovascular Disease	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	386693863A	MEDICAID	GEORGIA
2	511G70144	MEDICARE PIN	GEORGIA

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: 4/28/2024

NPI Synchronization or Removal

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