NPIMap

Organization Active NPI

Wellstar Kennestone Pediatric Associates, LLC

  • Pediatrics Physician
  • Marietta, GA
National Provider Identifier
1083660682
Registry record updated Jul 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES, LLC
Practice address
1371 Church Street Ext NE
Marietta, GA 30060-7913
Phone
(770) 422-8315
Fax
(770) 590-9170
NPI assigned
May 25, 2006
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
Nicole Ashe
Title
Executive Director of Finance
Phone
(770) 792-5261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

1371 Church Street Ext NE
Marietta, GA 30060-7913

Mailing address

1371 Church Street Ext NE
Marietta, GA 30060-7913
Phone (770) 422-8315

National Provider Directory

National Provider Directory
Part of
NW Ga Nealth Systems in

Practitioners & affiliated clinicians

Practitioners 8

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": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1083660682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1371 CHURCH STREET EXT NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607913",
            "telephone_number": "770-422-8315",
            "fax_number": "770-590-9170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1371 CHURCH STREET EXT NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607913",
            "telephone_number": "770-422-8315",
            "fax_number": "770-590-9170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR KENNESTONE PEDIATRIC ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2006-05-25",
        "last_updated": "2008-07-14",
        "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": "770-792-5261"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, 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.