NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar Family Medicine (Willow Creek)

  • Family Medicine Physician
  • Roswell, GA
National Provider Identifier
1922405729
Registry record updated Feb 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar Family Medicine (Willow Creek)
Practice address
11685 Alpharetta Hwy
Suite 300
Roswell, GA 30076-4910
Phone
(678) 325-6611
Fax
(678) 325-6616
NPI assigned
Nov 24, 2014
Last updated
Feb 18, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 18, 2015

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
(470) 644-0095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X GA Primary

Addresses

Primary practice location

11685 Alpharetta Hwy
Suite 300
Roswell, GA 30076-4910

Mailing address

11685 Alpharetta Hwy
Suite 300
Roswell, GA 30076-4910
Phone (678) 325-6611

Other names 1

  • WellStar Family Medicine (Willow Creek) 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
Wellstar Medical Group East Paulding Pediatrics126 organizations share this tax ID, including this one
Part of
Wellstar Medical Group East Paulding Pediatrics

Organizations with this tax ID in the same state 19

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

View all 19

Locations

11685 Alpharetta Hwy
Ste 300
Roswell, GA 30076
Phone (678) 325-6611

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": "1416787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424217600000",
    "number": "1922405729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11685 ALPHARETTA HWY",
            "address_2": "SUITE 300",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764910",
            "telephone_number": "678-325-6611",
            "fax_number": "678-325-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11685 ALPHARETTA HWY",
            "address_2": "SUITE 300",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764910",
            "telephone_number": "678-325-6611",
            "fax_number": "678-325-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2014-11-24",
        "last_updated": "2015-02-18",
        "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": "470-644-0095",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Family Medicine (Willow Creek)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2015; 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.