NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Marietta Family Medicine

  • Family Medicine Physician
  • Marietta, GA
National Provider Identifier
1093011637
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Marietta Family Medicine
Practice address
114 Cherry St NE
Suite a
Marietta, GA 30060-7277
Phone
(770) 423-0895
Fax
(770) 429-8628
NPI assigned
Jan 30, 2011
Last updated
Nov 18, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

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

Authorized official

Name
Mrs. Nicole Ashe
Title
Executive Director of Finance
Phone
(470) 644-0095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X GA Primary

Addresses

Primary practice location

114 Cherry St NE
Suite a
Marietta, GA 30060-7277

Mailing address

114 Cherry St NE
Suite a
Marietta, GA 30060-7277
Phone (770) 423-0895

Other names 1

  • WellStar Marietta Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110127000374 GA Part B Supplier - Clinic/Group Practice 6709065402 Receives reassigned benefits from 4,219 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Wellstar Neurosurgery Services LLC Dba Wellstar Neurosurgery126 organizations share this tax ID, including this one
Part of
Wellstar Neurosurgery Services LLC Dba Wellstar Neurosurgery

Organizations with this tax ID in the same state 24

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

View all 24

Locations

114 Cherry St NE
Ste A
Marietta, GA 30060
Phone (770) 423-0895

1810 White Cir
Ste 105
Marietta, GA 30066
Phone (678) 797-6820

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1296345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1093011637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 CHERRY ST NE",
            "address_2": "SUITE A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607277",
            "telephone_number": "770-423-0895",
            "fax_number": "770-429-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 CHERRY ST NE",
            "address_2": "SUITE A",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607277",
            "telephone_number": "770-423-0895",
            "fax_number": "770-429-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2011-01-30",
        "last_updated": "2013-11-18",
        "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": "470-644-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Marietta Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 18, 2013; 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.