NPIMap

Organization Active NPI

Kennestone Hospital, Inc

Doing business as Wellstar Pharmacy Network

  • Clinic Pharmacy
  • Marietta, GA
National Provider Identifier
1275221095
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
Legal business name
KENNESTONE HOSPITAL, INC
Doing business as
Wellstar Pharmacy Network
Practice address
115 Cherry St NE
Marietta, GA 30060-7205
Phone
(470) 644-0328
NPI assigned
Apr 28, 2023
Last updated
Apr 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Authorized official

Name
Mr. Ebenezer Erzuah
Title
Exec. Director Reimbursement
Phone
(470) 956-4981

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X Primary

Addresses

Primary practice location

115 Cherry St NE
Marietta, GA 30060-7205

Mailing address

793 Sawyer Rd
Marietta, GA 30062-2222

Other names 1

  • Wellstar Pharmacy Network Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kennestone Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

115 Cherry St NE
Marietta, GA 30060
Phone (770) 793-5700

NPI Registry JSON

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

{
    "created_epoch": "1682640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682640000000",
    "number": "1275221095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 SAWYER RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CHERRY ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300607205",
            "telephone_number": "470-644-0328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESTONE HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-28",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A",
        "authorized_official_last_name": "ERZUAH",
        "authorized_official_first_name": "EBENEZER",
        "authorized_official_title_or_position": "EXEC. DIRECTOR REIMBURSEMENT",
        "authorized_official_telephone_number": "470-956-4981",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellstar Pharmacy Network",
            "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 Apr 28, 2023; 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.