NPIMap

Wellstar Medical Group, LLC

Organization Active NPI Family Medicine Physician · Acworth, GA

NPI 1821352964 · NPPES record last updated Jul 3, 2012

Key facts

NPI
1821352964
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Practice address
4550 Cobb Parkway NW
Suite 201
Acworth, GA 30101
Phone
(770) 974-4655
Fax
(770) 974-7534
NPI assigned
Jul 3, 2012
Organization subpart
Yes
Parent organization (as reported)
WELLSTAR MEDICAL GROUP, LLC

Authorized official

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

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Wellstar Medical Group LLC (125 organizations share this tax ID)
Part of
Wellstar Medical Group LLC

Locations

4550 Cobb Parkway North NW
Ste 201
Acworth, GA 30101
Phone (770) 917-8180

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X GA Yes
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X GA

Addresses

Primary practice location

4550 Cobb Parkway NW
Suite 201
Acworth, GA 30101

Mailing address

4550 Cobb Parkway NW
Suite 201
Acworth, GA 30101
Phone (770) 974-4655

Other names

  • WellStar Family Medicine & Internal Medicine AHP Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 3, 2012.

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1821352964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NW",
            "address_2": "SUITE 201",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "30101",
            "telephone_number": "770-974-4655",
            "fax_number": "770-974-7534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 COBB PARKWAY NW",
            "address_2": "SUITE 201",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "30101",
            "telephone_number": "770-974-4655",
            "fax_number": "770-974-7534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2012-07-03",
        "last_updated": "2012-07-03",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Family Medicine & Internal Medicine AHP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Acworth, GA

All providers in Acworth, GA · Family Medicine Physician in Georgia

Sources for this page

Verify at the official NPI Registry.