NPIMap

Organization Active NPI

Wellstreet of Georgia PC

Doing business as Piedmont Urgent Care by Wellstreet

  • Non-Pharmacy Dispensing Site
  • Conyers, GA
National Provider Identifier
1063061315
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
WELLSTREET OF GEORGIA PC
Doing business as
Piedmont Urgent Care by Wellstreet
Practice address
1280 Dogwood Dr SE
Conyers, GA 30013-5046
Phone
(404) 994-4662
Fax
(404) 994-4663
NPI assigned
Sep 10, 2019
Last updated
Sep 10, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTREET OF GEORGIA PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Authorized official

Name
Keesha D. Pinacle, CREDENTIALING
Title
Cred MGR
Phone
(770) 809-3036

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

1280 Dogwood Dr SE
Conyers, GA 30013-5046

Mailing address

3350 Riverwood Pkwy SE Ste 1850
Atlanta, GA 30339-3300
Phone (770) 809-3036

Other identifiers 1

IdentifierTypeStateIssuer
003137211AMedicaidGA

Other names 1

  • Piedmont Urgent Care by Wellstreet Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2171784Piedmont Urgent Care by Wellstreet1280 Dogwood Drive, SE, Conyers, GA 30013Certificate of waiverSep 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Wellstreet of Georgia PC93 organizations share this tax ID, including this one
Part of
Wellstreet of Georgia PC

Organizations with this tax ID in the same state 18

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

View all 18

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568073600000",
    "number": "1063061315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 RIVERWOOD PKWY SE STE 1850",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393300",
            "telephone_number": "770-809-3036",
            "fax_number": "404-662-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 DOGWOOD DR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300135046",
            "telephone_number": "404-994-4662",
            "fax_number": "404-994-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTREET OF GEORGIA PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTREET OF GEORGIA PC",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A",
        "authorized_official_last_name": "PINACLE",
        "authorized_official_first_name": "KEESHA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CRED MGR",
        "authorized_official_telephone_number": "770-809-3036",
        "authorized_official_credential": "CREDENTIALING"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137211A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Urgent Care by Wellstreet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.