NPIMap

Organization Active NPI

Wellstar Healthcare System

  • Adolescent and Children Mental Health Clinic/Center
  • Marietta, GA
National Provider Identifier
1275879595
Registry record updated Dec 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
PT007517 Issued in GA
Legal business name
WELLSTAR HEALTHCARE SYSTEM
Practice address
818 Church St NE
Marietta, GA 30060-8969
Phone
(770) 792-5284
Fax
(770) 792-1513
NPI assigned
Dec 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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

Authorized official

Name
Tammy M Bennett, MA
Title
Revenue Management
Phone
(770) 792-5284

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X PT007517 GA Primary

Addresses

Primary practice location

818 Church St NE
Marietta, GA 30060-8969

Mailing address

805 Sandy Plains Rd
Attention: Revenue Management
Marietta, GA 30066-6340
Phone (770) 792-5284

Other names 1

  • WellStar Health Ventures Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1275879595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 SANDY PLAINS RD",
            "address_2": "ATTENTION: REVENUE MANAGEMENT",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666340",
            "telephone_number": "770-792-5284",
            "fax_number": "770-792-1513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608969",
            "telephone_number": "770-792-5284",
            "fax_number": "770-792-1513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-13",
        "last_updated": "2012-12-13",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "REVENUE MANAGEMENT",
        "authorized_official_telephone_number": "770-792-5284",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "GA",
            "license": "PT007517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Health Ventures",
            "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 Dec 13, 2012; 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.