NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Internal Medicine at Princeton Lakes

  • Internal Medicine Physician
  • Atlanta, GA
National Provider Identifier
1205267192
Registry record updated Dec 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Internal Medicine at Princeton Lakes
Practice address
3885 Princeton Lakes Way SW
Suite 300
Atlanta, GA 30331-5589
Phone
(404) 344-0059
Fax
(404) 344-0059
NPI assigned
Dec 3, 2013
Last updated
Dec 3, 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 Dec 3, 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
Internal Medicine Physician 207R00000X GA Primary

Addresses

Primary practice location

3885 Princeton Lakes Way SW
Suite 300
Atlanta, GA 30331-5589

Mailing address

3885 Princeton Lakes Way SW
Suite 300
Atlanta, GA 30331-5589
Phone (404) 344-0059

Other names 1

  • WellStar Internal Medicine at Princeton Lakes 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
Pulmonary Wellstar125 organizations share this tax ID, including this one
Part of
Pulmonary Wellstar

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

3885 Princeton Lakes Way SW
Ste 300
Atlanta, GA 30331
Phone (404) 344-0059

Practitioners & affiliated clinicians

Practitioners 6

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": "1386028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386028800000",
    "number": "1205267192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3885 PRINCETON LAKES WAY SW",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315589",
            "telephone_number": "404-344-0059",
            "fax_number": "404-344-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3885 PRINCETON LAKES WAY SW",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303315589",
            "telephone_number": "404-344-0059",
            "fax_number": "404-344-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2013-12-03",
        "last_updated": "2013-12-03",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Internal Medicine at Princeton Lakes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.