NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
National Provider Identifier
1558664003
Registry record updated Nov 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Family Medicine ACW
Practice address
5150 Stilesboro Rd NW
Suite 120
Kennesaw, GA 30152-7744
Phone
(678) 354-0230
Fax
(678) 354-0828
NPI assigned
Dec 6, 2010
Last updated
Nov 19, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2013

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

Authorized official

Name
Mrs. Nicole Ashe
Title
Executive Director of Finance
Phone
(470) 644-0095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X GA Primary

Addresses

Primary practice location

5150 Stilesboro Rd NW
Suite 120
Kennesaw, GA 30152-7744

Mailing address

5150 Stilesboro Rd NW
Suite 120
Kennesaw, GA 30152-7744
Phone (678) 354-0230

Other names 1

  • WellStar Family Medicine ACW Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110127000374 GA Part B Supplier - Clinic/Group Practice 6709065402 Receives reassigned benefits from 4,219 practitioners

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Pulmonary Wellstar

Locations

5150 Stilesboro Rd NW
Kennesaw, GA 30152
Phone (678) 354-0230

5150 Stilesboro Rd NW
Ste 120
Kennesaw, GA 30152
Phone (678) 354-0230

3747 Roswell Rd
Ste 205
Marietta, GA 30062
Phone (470) 956-9050

55 Whitcher St NE
Ste 160
Marietta, GA 30060
Phone (770) 590-4180

4581 S Cobb Dr SE
Ste 100
Smyrna, GA 30080
Phone (770) 801-5000

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
A G Rhodes Home Cobb IncMarietta, GA, CCN 115521 Skilled nursing facility Adp of the SNF Jun 5, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4,396

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 4,396

NPI Registry JSON

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

{
    "created_epoch": "1291593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384819200000",
    "number": "1558664003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 STILESBORO RD NW",
            "address_2": "SUITE 120",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527744",
            "telephone_number": "678-354-0230",
            "fax_number": "678-354-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 STILESBORO RD NW",
            "address_2": "SUITE 120",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527744",
            "telephone_number": "678-354-0230",
            "fax_number": "678-354-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2010-12-06",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Family Medicine ACW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kennesaw, GA

Sources for this page

Verify at the official NPI Registry.