Organization Active NPI

Wellspring MD LLC

  • Family Medicine Physician
  • Atlanta, GA
National Provider Identifier
1235944935
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLSPRING MD LLC
Practice address
4300 Paces Ferry Rd SE Ste 500
Atlanta, GA 30339-5714
Phone
(484) 763-0707
NPI assigned
Feb 10, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Authorized official

Name
Jason PD BaileyNPI 1689331696
Title
Owner
Phone
(470) 339-4306

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4300 Paces Ferry Rd SE Ste 500
Atlanta, GA 30339-5714

Mailing address

4300 Paces Ferry Rd SE Ste 500
Atlanta, GA 30339-5714
Phone (470) 339-4306

Other practice location 1

11175 Cicero Dr Ste 147
Alpharetta, GA 30022-1179
Phone (470) 339-4306

Other practice location 2

4405 Northside Pkwy NW Apt 2103
Atlanta, GA 30327-5203
Phone (470) 339-4306

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250523001201 GA Part B Supplier - Clinic/Group Practice 0749709681 Receives reassigned benefits from 1 practitioner
Practice locations: Alpharetta, GA; Atlanta, GA

National Provider Directory

National Provider Directory

Locations

11175 Cicero Dr
Ste 147
Alpharetta, GA 30022
Phone (470) 339-4306

11175 Cicero Dr
Ste 200
Alpharetta, GA 30022
Phone (470) 339-4306

Practitioners & affiliated clinicians

Practitioners 2

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": "1739145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1235944935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 PACES FERRY RD SE STE 500",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395714",
            "telephone_number": "470-339-4306",
            "fax_number": "470-284-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 PACES FERRY RD SE STE 500",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395714",
            "telephone_number": "484-763-0707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11175 Cicero Dr Ste 147",
            "address_purpose": "LOCATION",
            "city": "Alpharetta",
            "state": "GA",
            "postal_code": "300221179",
            "country_code": "US",
            "telephone_number": "470-339-4306",
            "fax_number": "470-284-0215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4405 Northside Pkwy NW Apt 2103",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303275203",
            "country_code": "US",
            "telephone_number": "470-339-4306",
            "fax_number": "470-284-0215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WELLSPRING MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-10",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "PD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "470-339-4306"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Sep 22, 2025; 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.