NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Physicians Group ENT

  • Otolaryngology Physician
  • Marietta, GA
National Provider Identifier
1881990455
Registry record updated Jan 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Physicians Group ENT
Practice address
320 Kennestone Hospital Blvd
Suite 107
Marietta, GA 30060-1161
Phone
(770) 793-7613
Fax
(770) 793-7413
NPI assigned
Jan 31, 2011
Last updated
Jan 31, 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 Jan 31, 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
Otolaryngology Physician 207Y00000X GA Primary

Addresses

Primary practice location

320 Kennestone Hospital Blvd
Suite 107
Marietta, GA 30060-1161

Mailing address

320 Kennestone Hospital Blvd
Suite 107
Marietta, GA 30060-1161
Phone (770) 793-7613

Other names 1

  • WellStar Physicians Group ENT Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110127000374 GA Part B Supplier - Clinic/Group Practice 6709065402 Receives reassigned benefits from 4,219 practitioners
This NPI is an additional NPI on the enrollment

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 22

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

View all 22

Locations

320 Kennestone Hospital Blvd
Ste 107
Marietta, GA 30060
Phone (770) 793-7417

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1881990455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 KENNESTONE HOSPITAL BLVD",
            "address_2": "SUITE 107",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601161",
            "telephone_number": "770-793-7613",
            "fax_number": "770-793-7413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 KENNESTONE HOSPITAL BLVD",
            "address_2": "SUITE 107",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601161",
            "telephone_number": "770-793-7613",
            "fax_number": "770-793-7413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2011-01-31",
        "last_updated": "2011-01-31",
        "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": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Physicians Group ENT",
            "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 Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.