NPIMap

Organization Active NPI

Douglas Hospital, Inc.

Doing business as Wellstar Douglas Hospital

  • General Acute Care Hospital
  • Douglasville, GA
National Provider Identifier
1649247974
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
DOUGLAS HOSPITAL, INC.
Doing business as
Wellstar Douglas Hospital
Practice address
8954 Hospital Dr
Douglasville, GA 30134-2272
Phone
(770) 949-1500
Fax
(770) 792-1784
NPI assigned
Mar 7, 2006
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Anthony J Budzinski
Title
Evp and Chief Financial Officer
Phone
(470) 644-0012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

8954 Hospital Dr
Douglasville, GA 30134-2272

Mailing address

793 Sawyer Rd
Marietta, GA 30062-2222
Phone (470) 644-0012

Other identifiers 2

IdentifierTypeStateIssuer
100084OtherGABLUE CROSS
00000624AMedicaidGA

Other names 1

  • Wellstar Douglas Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080501000646 GA Part A Provider - Hospital 5294633939 Practice locations: Douglasville, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649247974. Details of each certification follow.

Hospital certification: CCN 110184

Legal name
DOUGLAS HOSPITAL, INC.
Doing business as
WELLSTAR DOUGLAS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Aug 6, 1974
Last certification
Mar 20, 2026
Beds
108 (20 certified)
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jul 1, 1993 (1 total)
Organization structure
OtherNon-profit
Incorporated
Sep 18, 1992 in GA
Enrollment address
8954 Hospital Dr
Douglasville, GA 30134-2272
Other Hospital Practice Location
Hospital subgroups
Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Wellstar Douglas Medical CenterCCN 110184 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
11D0256511Wellstar Douglas Hospital Laboratory8954 Hospital Dr, Douglasville, GA 30134AccreditationAug 16, 2027
11D0999122Wellstar Douglas Hospital Nursing8954 Hospital Drive, Douglasville, GA 30134Certificate of waiverMay 5, 2028

National Provider Directory

National Provider Directory

Locations

1121 Johnson Ferry Rd
Ste 150
Marietta, GA 30068
Phone (770) 977-1510

Ownership & related parties

All disclosed owners & managing parties 23

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William C Brock Individual Corporate DirectorBoard Member Jul 1, 2015 5%
Avril Patricia Beckford Individual Corporate DirectorBoard Member Sep 22, 2011 5%
Terrell Johnson Individual Corporate DirectorBoard Member Jun 30, 2011 5%
Orrin S Swayze Individual Corporate DirectorBoard Member Jul 1, 2014
John C McKibben Individual Corporate DirectorBoard Member Aug 1, 2019 5%
Hiram Speer Burdette Individual Corporate DirectorBoard Member Apr 1, 2016 5%
Paul Lawrence Douglass Individual Corporate DirectorBoard Member Aug 22, 2016 5%
Mitzi Moore Individual Corporate DirectorBoard Member Jul 1, 2014 5%
Ambica Yadav Individual Corporate DirectorBoard Member Mar 2, 2017 5%
Wellstar Health System Inc Organization, Marietta, GA 5% Or Greater Direct Ownership Interest Nov 6, 2007 100%
Operational/Managerial Control Nov 6, 2007 100%
James Glen Cunningham Individual Corporate DirectorBoard Member Mar 4, 2021 5%
Anthony Budzinski Individual Corporate OfficerExec Vice President & Cfo Jul 7, 2008 100%
W-2 Managing EmployeeExec Vice President & Cfo Jul 7, 2008
Ebenezer Erzuah Individual W-2 Managing EmployeeExec Director of Reimbursement Jul 20, 2009
Mark Berry Individual Corporate DirectorBoard Member Oct 7, 2021 5%
James Holmes Individual Corporate DirectorBoard Member Apr 4, 2016 5%
Candice Saunders Individual Corporate OfficerPresident and Ceo Jul 1, 2015 100%
W-2 Managing EmployeePresident and Ceo Jul 1, 2015 100%
James Swartz Individual Corporate OfficerVice President of Finance Oct 1, 2010
W-2 Managing EmployeeVice President of Finance Oct 1, 2010
Greg Morgan Individual Corporate DirectorBoard Member Jul 1, 2014 5%
James L Hornsby Individual Corporate DirectorBoard Member Jul 1, 2018 5%
Edward Richardson Individual Corporate DirectorBoard Member Apr 4, 2019 5%
Arif Abdul Aziz Individual Corporate DirectorBoard Member Jul 1, 2019 5%
David Bottoms Individual Corporate DirectorBoard Member Feb 2, 2023 5%
Frank Ros Individual Corporate DirectorBoard Member Jun 30, 2012 5%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 18

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 18

Practitioners & affiliated clinicians

Practitioners 67

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 67

Affiliated clinicians 668

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 668

NPI Registry JSON

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1649247974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 SAWYER RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622222",
            "telephone_number": "470-644-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8954 HOSPITAL DR",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342272",
            "telephone_number": "770-949-1500",
            "fax_number": "770-792-1784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "BUDZINSKI",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EVP AND CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "470-644-0012"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "100084",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00000624A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Wellstar Douglas Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Douglasville, GA

Sources for this page

Verify at the official NPI Registry.