NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Breast Surgery

  • Surgery Physician
  • Acworth, GA
National Provider Identifier
1760815732
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Breast Surgery
Practice address
4550 Cobb Parkway North NW
Acworth, GA 30101-4180
Phone
(770) 917-8142
Fax
(770) 966-8864
NPI assigned
Aug 14, 2013
Last updated
Aug 14, 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 Aug 14, 2013

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

Authorized official

Name
Nicole Ashe
Title
Executive Director of Finance
Phone
(770) 792-5261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X GA Primary

Addresses

Primary practice location

4550 Cobb Parkway North NW
Acworth, GA 30101-4180

Mailing address

4550 Cobb Parkway North NW
Acworth, GA 30101-4180
Phone (770) 917-8142

Other names 1

  • WellStar Breast Surgery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pulmonary Wellstar125 organizations share this tax ID, including this one
Part of
Pulmonary Wellstar

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

Locations

4550 Cobb Parkway North NW
Acworth, GA 30101
Phone (470) 956-0005

NPI Registry JSON

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

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1760815732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NORTH NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014180",
            "telephone_number": "770-917-8142",
            "fax_number": "770-966-8864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NORTH NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301014180",
            "telephone_number": "770-917-8142",
            "fax_number": "770-966-8864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2013-08-14",
        "last_updated": "2013-08-14",
        "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": "770-792-5261"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Breast Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Acworth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; 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.