Active NPI
Wellstar Pediatric & Family Wellness Center, LLC
- Clinical Psychologist
- Austell, GA
National Provider Identifier
1073742482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Legal business name
- WELLSTAR PEDIATRIC & FAMILY WELLNESS CENTER, LLC
- Practice address
- 1810 Mulkey Rd
Suite 201
Austell, GA 30106-1151 - Phone
- (770) 634-2349
- Fax
- (770) 819-0597
- NPI assigned
- Jul 7, 2009
- Last updated
- Jul 7, 2009
- Organization subpart
- Yes
- Parent organization
- WELLSTAR HEALTH SYSTEM
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nicole Ashe
- Title
- Asst; VP of Finance
- Phone
- (770) 792-5261
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | Primary |
Addresses
Primary practice location
1810 Mulkey Rd
Suite 201
Austell, GA 30106-1151
Mailing address
1810 Mulkey Rd
Suite 201
Austell, GA 30106-1151
Phone (770) 634-2349
National Provider Directory
National Provider Directory- Part of
- Wellstar Behavioral Hea
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246924800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1246924800000",
"number": "1073742482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1810 MULKEY RD",
"address_2": "SUITE 201",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061151",
"telephone_number": "770-634-2349",
"fax_number": "770-819-0597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1810 MULKEY RD",
"address_2": "SUITE 201",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301061151",
"telephone_number": "770-634-2349",
"fax_number": "770-819-0597"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLSTAR PEDIATRIC & FAMILY WELLNESS CENTER, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM",
"enumeration_date": "2009-07-07",
"last_updated": "2009-07-07",
"status": "A",
"authorized_official_last_name": "ASHE",
"authorized_official_first_name": "NICOLE",
"authorized_official_title_or_position": "ASST; VP OF FINANCE",
"authorized_official_telephone_number": "770-792-5261"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
- Wellstar Medical Group, LLC (WellStar Palliative Medicine)
- Wellstar Medical Group, LLC (WellStar Bi-County ENT)
- Wellstar Occupational Health, LLC
- Wellstar Palliative Medicine, LLC
- Wellstar Pediatric & Adolescent Center, LLC
- Wellstar Physicians Group Pathologists, LLC
- Wellstar South Cobb Primary Care, LLC
- Wellstar South Cobb Rheumatology, LLC
- Wellstaris Medical Equipment & Supply Corp
- Wellstaris Medical Equipment & Supply Corp
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.