Wellstar Shallowford Medical Center, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WELLSTAR SHALLOWFORD MEDICAL CENTER, LLC

Practice address

3921 Shallowford Rd
Marietta, GA 30062-5013

Phone

(770) 649-9100

Fax

(770) 949-9092

NPI assigned

May 26, 2006

Last updated

Jul 14, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

WELLSTAR HEALTH SYSTEM, INC.As reported in NPPES

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

Addresses

Part of

Wellstar Behavioral Hea

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1144276270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3921 SHALLOWFORD RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625013",
            "telephone_number": "770-649-9100",
            "fax_number": "770-949-9092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3921 SHALLOWFORD RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300625013",
            "telephone_number": "770-649-9100",
            "fax_number": "770-949-9092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR SHALLOWFORD MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2006-05-26",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Internal Medicine Physician in Georgia

• 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.