NPIMap

Wellstar Medical Group, LLC

Organization Active NPI Internal Medicine Physician · Douglasville, GA

NPI 1386940922 · NPPES record last updated Nov 19, 2013

Key facts

NPI
1386940922
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Practice address
8820 Hospital Dr
Douglasville, GA 30134-2266
Phone
(770) 947-3000
Fax
(770) 947-3012
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

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

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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 (125 organizations share this tax ID)
Part of
Wellstar Medical Group LLC

Locations

51 Hiram Dr
Ste B
Hiram, GA 30141
Phone (678) 945-8300

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207R00000X GA Yes

Addresses

Primary practice location

8820 Hospital Dr
Douglasville, GA 30134-2266

Mailing address

8820 Hospital Dr
Douglasville, GA 30134-2266
Phone (770) 947-3000

Other names

  • WellStar Douglasville Medical Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 19, 2013.

{
    "created_epoch": "1296345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1386940922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8820 HOSPITAL DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342266",
            "telephone_number": "770-947-3000",
            "fax_number": "770-947-3012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8820 HOSPITAL DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342266",
            "telephone_number": "770-947-3000",
            "fax_number": "770-947-3012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2011-01-30",
        "last_updated": "2013-11-19",
        "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": "470-644-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Douglasville Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglasville, GA

All providers in Douglasville, GA · Internal Medicine Physician in Georgia

Sources for this page

Verify at the official NPI Registry.