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WELLSTAR MEDICAL GROUP LLC NPI 1922405729


NPI Information

NPI: 1922405729
Provider Name: WELLSTAR MEDICAL GROUP, LLC

Doing Business As: WELLSTAR FAMILY MEDICINE (WILLOW CREEK)

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 11D2056074

Address:
11685 ALPHARETTA HWY
SUITE 300
ROSWELL, GA
ZIP 30076
Phone: (678) 325-6611
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WELLSTAR MEDICAL GROUP, LLC is a family medicine in Roswell, 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 1922405729. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Wellstar Family Medicine (willow Creek).

The provider's business location address is:

11685 ALPHARETTA HWY
SUITE 300
ROSWELL, GA
ZIP 30076-910
Phone: (678) 325-6611
Fax: (678) 325-6616

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 11D2056074 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/24/2014 and was last updated on 2/18/2015.


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
1207Q00000XFamily MedicineGEORGIAYes

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

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