NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Complex Care Clinic

  • Endocrinology, Diabetes & Metabolism Physician
  • Marietta, GA
National Provider Identifier
1790189983
Registry record updated Oct 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Complex Care Clinic
Practice address
355 Tower Rd NE
1St Floor
Marietta, GA 30060-9408
Phone
(470) 644-0029
Fax
(770) 499-0352
NPI assigned
Oct 16, 2014
Last updated
Oct 16, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2014

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

Authorized official

Name
Mrs. Nicole Ashe
Title
Executive Director of Finance
Phone
(470) 644-0095

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X GA
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X GA Primary

Addresses

Primary practice location

355 Tower Rd NE
1St Floor
Marietta, GA 30060-9408

Mailing address

355 Tower Rd NE
1St Floor
Marietta, GA 30060-9408
Phone (470) 644-0029

Other names 1

  • WellStar Complex Care Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Christopher Dennis MD PLLC126 organizations share this tax ID, including this one
Part of
Christopher Dennis MD PLLC

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

355 Tower Rd NE
Fl 1
Marietta, GA 30060
Phone (470) 644-0029

NPI Registry JSON

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

{
    "created_epoch": "1413417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413417600000",
    "number": "1790189983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 TOWER RD NE",
            "address_2": "1ST FLOOR",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300609408",
            "telephone_number": "470-644-0029",
            "fax_number": "770-499-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 TOWER RD NE",
            "address_2": "1ST FLOOR",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300609408",
            "telephone_number": "470-644-0029",
            "fax_number": "770-499-0352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2014-10-16",
        "last_updated": "2014-10-16",
        "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": "470-644-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Complex Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; 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.