WELLSTAR MEDICAL GROUP LLC NPI 1790100170

NPI Information

NPI: 1790100170
Provider Name: WELLSTAR MEDICAL GROUP, LLC

Doing Business As: WELLSTAR KENNESAW STATE UNIVERSITY STUDENT HEALTH SERVICES

Classification: Clinic/Center - 261QS1000X
Entity Type: Organization

Specialization: Student Health

Address:
3215 CAMPUS LOOP RD NW
KENNESAW, GA
ZIP 30144
Phone: (470) 578-6531
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WELLSTAR MEDICAL GROUP, LLC is a student health clinic center in Kennesaw, GA. WELLSTAR MEDICAL GROUP, LLC NPI is 1790100170. The provider is registered as an organization entity type.
The provider Is Doing Business As Wellstar Kennesaw State University Student Health Services.

The provider's business location address is:

3215 CAMPUS LOOP RD NW
KENNESAW, GA
ZIP 30144-227
Phone: (470) 578-6531
Fax: (470) 578-9004

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 enumeration date for this NPI number is 2/21/2014 and was last updated on 5/27/2015.

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
1	261QS1000X	Clinic/Center	Student Health		GEORGIA	Yes

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: 5/5/2024

NPI Synchronization or Removal

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