NPIMap

Organization Active NPI

Wellstreet of Georgia PC

Doing business as Piedmont Urgentcare by Wellstreet

  • Non-Pharmacy Dispensing Site
  • Loganville, GA
National Provider Identifier
1861980955
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
WELLSTREET OF GEORGIA PC
Doing business as
Piedmont Urgentcare by Wellstreet
Practice address
4763 Atlanta Hwy Ste 420
Loganville, GA 30052-6788
Phone
(470) 395-6793
NPI assigned
Apr 25, 2018
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Samantha Alvord
Title
Practice Manager
Phone
(770) 521-6690

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X NU Primary

Addresses

Primary practice location

4763 Atlanta Hwy Ste 420
Loganville, GA 30052-6788

Mailing address

3350 Riverwood Pkwy SE Ste 1850
Atlanta, GA 30339-3300

Other identifiers 1

IdentifierTypeStateIssuer
003179873AMedicaidGA

Other names 1

  • Piedmont Urgentcare by Wellstreet Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2102561Piedmont Urgentcare by Wellstreet4763 Atlanta Hwy, Ste 410, Loganville, GA 30052Certificate of waiverSep 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Wellstreet of Georgia PC93 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 20

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 20

Locations

4763 Atlanta Hwy
Ste 420
Loganville, GA 30052
Phone (404) 395-6781

NPI Registry JSON

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

{
    "created_epoch": "1524614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1861980955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 RIVERWOOD PKWY SE STE 1850",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4763 ATLANTA HWY STE 420",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300526788",
            "telephone_number": "470-395-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTREET OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-25",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ALVORD",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "770-521-6690"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003179873A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Piedmont Urgentcare by Wellstreet",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.