Individual provider Active NPI

Candace Colston

  • Nurse Practitioner
  • Dallas, GA
National Provider Identifier
1730574450
Registry record updated Mar 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN138876 Issued in GA
Practice address
600 W Memorial Dr
Dallas, GA 30132-4117
Phone
(470) 644-7000
NPI assigned
Mar 31, 2015
Last updated
Mar 31, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN138876 GA Primary
Registered Nurse 163W00000X RN138876 GA

Addresses

Primary practice location

600 W Memorial Dr
Dallas, GA 30132-4117

Mailing address

5665 New Northside Dr
Suite 320
Atlanta, GA 30328-5831
Phone (770) 874-6907

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171116002728 GA Practitioner - Nurse Practitioner 7810253218 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN138876GAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Dec 7, 2020 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Dec 7, 2020 Accepting new patients
Peachtree Immediate Care FP, LLC CurrentSince Aug 6, 2017 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients

Locations

600 W Memorial Dr
Dallas, GA 30132
Phone (770) 443-7072

1275 Highway 54 W
Ste 201
Fayetteville, GA 30214
Phone (770) 461-3776

590 Lanier Ave W
Fayetteville, GA 30214

3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1427760000000",
    "number": "1730574450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR",
            "address_2": "SUITE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285831",
            "telephone_number": "770-874-6907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W MEMORIAL DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324117",
            "telephone_number": "470-644-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLSTON",
        "first_name": "CANDACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2015-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN138876",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN138876",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, GA

Sources for this page

Verify at the official NPI Registry.