Organization Active NPI

Welgen One of Georgia LLC

  • General Practice Physician
  • Lawrenceville, GA
National Provider Identifier
1023746732
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
WELGEN ONE OF GEORGIA LLC
Practice address
5415 Sugarloaf Pkwy Ste 1108
Lawrenceville, GA 30043-7832
Phone
(833) 935-4361
NPI assigned
Aug 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

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

Authorized official

Name
Shanira Delacruz
Title
President
Phone
(201) 233-2155

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X
Clinical & Laboratory Immunology (Allergy & Immunology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207KI0005X
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary
Registered Record AdministratorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 246YR1600X
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

5415 Sugarloaf Pkwy Ste 1108
Lawrenceville, GA 30043-7832

Mailing address

309 E Paces Ferry Rd NE Ste 400
Atlanta, GA 30305-2319
Phone (770) 212-0015

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221212001041 GA Part B Supplier - Clinic/Group Practice 7315316452 Receives reassigned benefits from 2 practitioners
Practice locations: Atlanta, GA; Lawrenceville, GA

National Provider Directory

National Provider Directory

Locations

113 S Perry St
Lawrenceville, GA 30046

629 S 4th St
Ste 301
Louisville, KY 40202
Phone (833) 935-4361

Practitioners & affiliated clinicians

Practitioners 2

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": "1660089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1023746732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 E PACES FERRY RD NE STE 400",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303052319",
            "telephone_number": "770-212-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 SUGARLOAF PKWY STE 1108",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300437832",
            "telephone_number": "833-935-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELGEN ONE OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-10",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A",
        "authorized_official_last_name": "DELACRUZ",
        "authorized_official_first_name": "SHANIRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-233-2155"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207KI0005X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "246YR1600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Health Information, Registered Record Administrator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.