Wellstar Creekside Pediatrics, LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

WELLSTAR CREEKSIDE PEDIATRICS, LLC

Practice address

6095 Professional Pkwy
Suite 100
Douglasville, GA 30134-5607

Phone

(770) 920-2255

Fax

(770) 920-9963

NPI assigned

May 26, 2006

Last updated

Jul 14, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

WELLSTAR HEALTH SYSTEM, INC.As reported in NPPES

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

Authorized official

Name

Nicole Ashe

Title

Executive Director of Finance

Phone

(770) 792-5261

Specialties & licenses 1

Addresses

Part of

Wellstar Health Systems

Locations

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1346296837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6095 PROFESSIONAL PKWY",
            "address_2": "SUITE 100",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345607",
            "telephone_number": "770-920-2255",
            "fax_number": "770-920-9963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6095 PROFESSIONAL PKWY",
            "address_2": "SUITE 100",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345607",
            "telephone_number": "770-920-2255",
            "fax_number": "770-920-9963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR CREEKSIDE PEDIATRICS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2006-05-26",
        "last_updated": "2008-07-14",
        "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": "770-792-5261"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.