Wellstar Physicians Group ENT, LLC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

Legal business name

WELLSTAR PHYSICIANS GROUP ENT, LLC

Practice address

504 W Memorial Dr
Dallas, GA 30132-4119

Phone

(770) 505-7190

Fax

(770) 793-7413

NPI assigned

Aug 31, 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 Behavioral Hea

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1477664613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 W MEMORIAL DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324119",
            "telephone_number": "770-505-7190",
            "fax_number": "770-793-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W MEMORIAL DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324119",
            "telephone_number": "770-505-7190",
            "fax_number": "770-793-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR PHYSICIANS GROUP ENT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2006-08-31",
        "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": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Watson
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• Wellstreet of Georgia PC
• Anna Wendt, OTR/L
• Belinda Lee Wenhold, LCSW
• Rachel Anne Werenski, OT
• West Metro Medical Transport, LLC

• Otolaryngology Physician in Dallas, GA
• Providers in Dallas, GA by specialty
• Otolaryngology 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.