NPIMap

Organization Active NPI

Wellstar Palliative Medicine, LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Austell, GA
National Provider Identifier
1063680049
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
WELLSTAR PALLIATIVE MEDICINE, LLC
Practice address
4040 Hospital West Dr
Austell, GA 30106-8117
Phone
(770) 732-6770
Fax
(770) 732-6710
NPI assigned
Feb 13, 2008
Last updated
Jul 14, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2008

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

Authorized official

Name
Charlene Bunts
Title
Director
Phone
(770) 732-6770

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X NU Primary

Addresses

Primary practice location

4040 Hospital West Dr
Austell, GA 30106-8117

Mailing address

4040 Hospital West Dr
Austell, GA 30106-8117
Phone (770) 732-6770

National Provider Directory

National Provider Directory
Part of
Wellstar Behavioral Hea

Practitioners & affiliated clinicians

Practitioners 8

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": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1063680049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 HOSPITAL WEST DR",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301068117",
            "telephone_number": "770-732-6770",
            "fax_number": "770-732-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 HOSPITAL WEST DR",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301068117",
            "telephone_number": "770-732-6770",
            "fax_number": "770-732-6710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR PALLIATIVE MEDICINE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "BUNTS",
        "authorized_official_first_name": "CHARLENE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "770-732-6770"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.