NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Pediatric & Family Wellness Center

  • Child & Adolescent Psychiatry Physician
  • Austell, GA
National Provider Identifier
1851684864
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Pediatric & Family Wellness Center
Practice address
1680 Hospital South Dr
Austell, GA 30106-8110
Phone
(770) 634-2349
Fax
(770) 941-9919
NPI assigned
May 24, 2011
Last updated
May 24, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2011

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
(770) 792-5261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X GA Primary

Addresses

Primary practice location

1680 Hospital South Dr
Austell, GA 30106-8110

Mailing address

1680 Hospital South Dr
Austell, GA 30106-8110
Phone (770) 634-2349

Other names 1

  • WellStar Pediatric & Family Wellness Center 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

NPI Registry JSON

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306195200000",
    "number": "1851684864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 HOSPITAL SOUTH DR",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301068110",
            "telephone_number": "770-634-2349",
            "fax_number": "770-941-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 HOSPITAL SOUTH DR",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301068110",
            "telephone_number": "770-634-2349",
            "fax_number": "770-941-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2011-05-24",
        "last_updated": "2011-05-24",
        "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": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Pediatric & Family Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 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.