NPIMap

Organization Active NPI

Wellstreet of Georgia PC

Doing business as Piedmont Urgent Care by Wellstreet

  • Non-Pharmacy Dispensing Site
  • Ellenwood, GA
National Provider Identifier
1619624681
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
WELLSTREET OF GEORGIA PC
Doing business as
Piedmont Urgent Care by Wellstreet
Practice address
4475 W Village Pkwy
Ellenwood, GA 30294-2869
Phone
(770) 507-7950
Fax
(770) 507-7978
NPI assigned
Mar 9, 2022
Last updated
Mar 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Katie Cassarino
Title
Practice Manager
Phone
(678) 414-2824

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

4475 W Village Pkwy
Ellenwood, GA 30294-2869

Mailing address

4475 W Village Pkwy
Ellenwood, GA 30294-2869
Phone (770) 507-7950

Other names 1

  • Piedmont Urgent Care by Wellstreet Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kcassarino@wellstreet.com

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2244464Piedmont Urgent Care by Wellstreet4475 West Village Parkway, Ellenwood, GA 30294Certificate of waiverDec 1, 2027

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": "1646784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1619624681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4475 W VILLAGE PKWY",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942869",
            "telephone_number": "770-507-7950",
            "fax_number": "770-507-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4475 W VILLAGE PKWY",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942869",
            "telephone_number": "770-507-7950",
            "fax_number": "770-507-7978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTREET OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-09",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "CASSARINO",
        "authorized_official_first_name": "KATIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "678-414-2824"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcassarino@wellstreet.com",
            "affiliation": "N",
            "address_1": "4475 W Village Pkwy",
            "city": "Ellenwood",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302942869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Piedmont Urgent Care by Wellstreet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellenwood, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.