NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Internal Medicine AHP

  • Internal Medicine Physician
  • Acworth, GA
National Provider Identifier
1003171422
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Internal Medicine AHP
Practice address
4550 Cobb Parkway North NW
Suite 201B
Acworth, GA 30101-4180
Phone
(770) 917-8160
Fax
(770) 529-1167
NPI assigned
Jul 11, 2012
Last updated
Nov 18, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Nicole Ashe
Title
Executive Director of Finance
Phone
(470) 644-0095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X GA Primary

Addresses

Primary practice location

4550 Cobb Parkway North NW
Suite 201B
Acworth, GA 30101-4180

Mailing address

4550 Cobb Parkway North NW
Suite 201B
Acworth, GA 30101-4180
Phone (770) 917-8160

Other names 1

  • WellStar Internal Medicine AHP Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110127000374 GA Part B Supplier - Clinic/Group Practice 6709065402 Receives reassigned benefits from 4,219 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Pulmonary Wellstar

Locations

4550 Cobb Parkway North NW
Ste 201B
Acworth, GA 30101
Phone (770) 917-8160

61 Whitcher St NE
Ste 3110
Marietta, GA 30060
Phone (770) 422-2326

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1003171422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NORTH NW",
            "address_2": "SUITE 201B",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014180",
            "telephone_number": "770-917-8160",
            "fax_number": "770-529-1167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NORTH NW",
            "address_2": "SUITE 201B",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014180",
            "telephone_number": "770-917-8160",
            "fax_number": "770-529-1167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2012-07-11",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "ASHE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "470-644-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Internal Medicine AHP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.