Wellstar Cobb Medical Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WELLSTAR COBB MEDICAL GROUP, LLC

Practice address

1790 Mulkey Rd
Suite 5a
Austell, GA 30106-1122

Phone

(770) 792-1055

Fax

(770) 732-0175

NPI assigned

May 23, 2006

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 Asche

Title

Executive Director of Finance

Phone

(770) 792-5261

Specialties & licenses 1

Addresses

Part of

NW Ga Nealth Systems in

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1356396022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 MULKEY RD",
            "address_2": "SUITE 5A",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061122",
            "telephone_number": "770-792-1055",
            "fax_number": "770-732-0175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 MULKEY RD",
            "address_2": "SUITE 5A",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061122",
            "telephone_number": "770-792-1055",
            "fax_number": "770-732-0175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR COBB MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "ASCHE",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "770-792-5261"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wellstar Atlanta General Surgery, LLC
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• Wellstar Cobb Family Medicine, LLC
• Wellstar Cobb Hospital Cancer Center LLC
• Wellstar Cobb Hospitalists, LLC
• Wellstar Cobb Rehabilitation Medicine, LLC
• Wellstar Cobb Surgical Associates, LLC
• Wellstar Community Hospice, LLC (WellStar Community Hospice)
• Wellstar Health System
• Wellstar Health Systems

• Internal Medicine Physician in Austell, GA
• Providers in Austell, GA by specialty
• Internal Medicine 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.