Organization Active NPI

Wellspring Medical Group, LLC

  • Primary Care Nurse Practitioner
  • Newnan, GA
National Provider Identifier
1477460707
Registry record updated Aug 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
WELLSPRING MEDICAL GROUP, LLC
Practice address
184 Jefferson Pkwy # B
Newnan, GA 30263-5822
Phone
(404) 759-9888
NPI assigned
Aug 24, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2026

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

Authorized official

Name
Mr. Eugene Ifeanyichukwu Ozim
Title
Owner
Phone
(770) 316-0102

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

184 Jefferson Pkwy # B
Newnan, GA 30263-5822

Mailing address

184 Jefferson Pkwy # B
Newnan, GA 30263-5822
Phone (404) 759-9888

NPI Registry JSON

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

{
    "created_epoch": "1787529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787529600000",
    "number": "1477460707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 JEFFERSON PKWY # B",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302635822",
            "telephone_number": "404-759-9888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 JEFFERSON PKWY # B",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302635822",
            "telephone_number": "404-759-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPRING MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-08-24",
        "last_updated": "2026-08-24",
        "certification_date": "2026-08-24",
        "status": "A",
        "authorized_official_last_name": "OZIM",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "IFEANYICHUKWU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-316-0102",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newnan, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.