Paulding Medical Center

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009764 Issued in GA

Legal business name

PAULDING MEDICAL CENTER

Practice address

600 W Memorial Dr
Wellstar Paulding Hospital
Dallas, GA 30132-4117

Phone

(770) 443-4780

Fax

(770) 443-4782

NPI assigned

Sep 12, 2011

Organization subpart

No

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

Authorized official

Name

T. Mark Haney

Title

Site Administrator

Phone

(770) 445-4411

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• WellStar Pharmacy Network Store #4 Doing business as

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315785600000",
    "number": "1770865248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "WELLSTAR PAULDING HOSPITAL",
            "address_2": "600 W. MEMORIAL DRIVE",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "30132",
            "telephone_number": "770-443-4780",
            "fax_number": "770-443-4782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 W MEMORIAL DR",
            "address_2": "WELLSTAR PAULDING HOSPITAL",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324117",
            "telephone_number": "770-443-4780",
            "fax_number": "770-443-4782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAULDING MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2011-09-12",
        "status": "A",
        "authorized_official_last_name": "HANEY",
        "authorized_official_first_name": "T. MARK",
        "authorized_official_title_or_position": "SITE ADMINISTRATOR",
        "authorized_official_telephone_number": "770-445-4411"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001438B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1161722",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Pharmacy Network Store #4",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paulding County Board of Education
• Paulding County Board of Health
• Paulding County Chiropractic
• Paulding Dermatology
• Paulding Enterprises, Inc.
• Paulding Medical Center, Inc.
• Peaceful Path Counseling, LLC
• Pediatric Dental Specialist of Acworth
• Pedozone, LLC
• Suzanne Pengelly

• Community/Retail Pharmacy in Dallas, GA
• Providers in Dallas, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.