NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

  • Rheumatology Physician
  • Smyrna, GA
National Provider Identifier
1023301033
Registry record updated Nov 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Practice address
4480 N Cooper Lake Rd SE
Suite 201
Smyrna, GA 30082-4622
Phone
(770) 333-2035
Fax
(770) 333-2059
NPI assigned
May 24, 2011
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 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
Rheumatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RR0500X GA Primary

Addresses

Primary practice location

4480 N Cooper Lake Rd SE
Suite 201
Smyrna, GA 30082-4622

Mailing address

4480 N Cooper Lake Rd SE
Suite 201
Smyrna, GA 30082-4622
Phone (770) 333-2035

Other names 1

  • WellStar Rheumatology 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
Tax ID family
Wellstar Medical Group LLC125 organizations share this tax ID, including this one
Part of
Wellstar Medical Group LLC

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1023301033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 N COOPER LAKE RD SE",
            "address_2": "SUITE 201",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300824622",
            "telephone_number": "770-333-2035",
            "fax_number": "770-333-2059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 N COOPER LAKE RD SE",
            "address_2": "SUITE 201",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300824622",
            "telephone_number": "770-333-2035",
            "fax_number": "770-333-2059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2011-05-24",
        "last_updated": "2013-11-19",
        "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": "207RR0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Rheumatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smyrna, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.