Wellstar Medical Group, LLC
Organization Active NPI Family Medicine Physician · Austell, GA
NPI 1295031839 · NPPES record last updated Nov 19, 2013
Key facts
- NPI
- 1295031839
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- WELLSTAR MEDICAL GROUP, LLC
- Practice address
- 1790 Mulkey Rd
Suite 8-a
Austell, GA 30106-1122 - Phone
- (770) 944-1830
- Fax
- (770) 739-0260
- NPI assigned
- Jan 30, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- WELLSTAR MEDICAL GROUP, LLC
Authorized official
- Name
- Mrs. Nicole Ashe
- Title
- Executive Director of Finance
- Phone
- (470) 644-0095
Corporate family (same tax ID) 24
Practitioners 12
-
Madison Hancock Boles, PA-C
-
Erica Judge Edwards, M.D.
-
Thomas Gearhard, M.D
-
Mariah A. Hamilton, PA-C
-
Lauren Bramlett Horn, NP-C
-
Rahul Kapoor, PA
-
Lisa Piper, PA
-
William Lewis Todd, FNP, AGACNP
-
Jay Trambadia, PSYD
-
Ramona Aranda, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Wellstar Medical Group LLC
- Part of
- Wellstar Medical Group LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | GA | Yes |
Addresses
Primary practice location
1790 Mulkey Rd
Suite 8-a
Austell, GA 30106-1122
Mailing address
1790 Mulkey Rd
Suite 8-a
Austell, GA 30106-1122
Phone (770) 944-1830
Other names
- WellStar Cobb Family Medicine
Other providers in Austell, GA
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
- Wellstar Medical Group, LLC
All providers in Austell, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.