Wellstar South Cobb Primary Care, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WELLSTAR SOUTH COBB PRIMARY CARE, LLC

Practice address

1680 Hospital South Dr
Austell, GA 30106-8110

Phone

(678) 945-2100

Fax

(770) 941-3870

NPI assigned

May 31, 2006

Organization subpart

Yes

Parent organization

WELLSTAR HEALTH SYSTEM, INC.As reported in NPPES

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

Authorized official

Name

Nicole Ashe

Title

Executive Director of Finance

Phone

(770) 792-5261

Specialties & licenses 1

Addresses

Part of

NW Ga Nealth Systems in

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1881631968",
    "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": "678-945-2100",
            "fax_number": "770-941-3870"
        },
        {
            "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": "678-945-2100",
            "fax_number": "770-941-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR SOUTH COBB PRIMARY CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR HEALTH SYSTEM, INC.",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-07-14",
        "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"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Austell, GA
• Providers in Austell, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.