NPIMap

Organization Active NPI

Wellstreet of Georgia PC

  • Clinic/Center
  • Newnan, GA
National Provider Identifier
1508239997
Registry record updated Dec 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WELLSTREET OF GEORGIA PC
Practice address
1825 Highway 34 E Ste 1200
Newnan, GA 30265-6416
Phone
(770) 502-2121
Fax
(770) 502-2113
NPI assigned
Nov 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2019

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

Authorized official

Name
Tonia R Davis
Title
Credentialing Manager
Phone
(770) 809-3036

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

1825 Highway 34 E Ste 1200
Newnan, GA 30265-6416

Mailing address

549 Bullsboro Dr
Newnan, GA 30265-1045
Phone (770) 502-2121

National Provider Directory

National Provider Directory
Tax ID family
Wellstreet of Georgia PC93 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1446768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575244800000",
    "number": "1508239997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 BULLSBORO DR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302651045",
            "telephone_number": "770-502-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 HIGHWAY 34 E STE 1200",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302656416",
            "telephone_number": "770-502-2121",
            "fax_number": "770-502-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTREET OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-06",
        "last_updated": "2019-12-02",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "TONIA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "770-809-3036"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "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 Dec 2, 2019; 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.