NPIMap

Organization Active NPI

Wellstar Medical Group, LLC

Doing business as WellStar KenMar Pediatrics

  • Pediatrics Physician
  • Marietta, GA
National Provider Identifier
1992001952
Registry record updated Nov 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Doing business as
WellStar KenMar Pediatrics
Practice address
760 Kennesaw Ave NW
Marietta, GA 30060-6909
Phone
(770) 427-0183
Fax
(770) 427-0788
NPI assigned
Feb 8, 2011
Last updated
Nov 18, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
WELLSTAR MEDICAL GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2013

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
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X GA Primary

Addresses

Primary practice location

760 Kennesaw Ave NW
Marietta, GA 30060-6909

Mailing address

760 Kennesaw Ave NW
Marietta, GA 30060-6909
Phone (770) 427-0183

Other names 1

  • WellStar KenMar Pediatrics 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 12

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

Locations

4900 Ivey Rd NW
Bldg 1300
Acworth, GA 30101

1180 Barrett Pkwy
#102
Kennesaw, GA 30144

1180 Ernest W Barrett Pkwy NW
Kennesaw, GA 30144
Phone (678) 354-2273

1180 Ernest W Barrett Pkwy NW
Ste 102A
Kennesaw, GA 30144
Phone (470) 956-9171

760 Kennesaw Ave NW
Marietta, GA 30060
Phone (770) 427-0183

4581 S Cobb Dr SE
Ste 100
Smyrna, GA 30080
Phone (470) 956-9171

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1992001952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606909",
            "telephone_number": "770-427-0183",
            "fax_number": "770-427-0788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 KENNESAW AVE NW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606909",
            "telephone_number": "770-427-0183",
            "fax_number": "770-427-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSTAR MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSTAR MEDICAL GROUP, LLC",
        "enumeration_date": "2011-02-08",
        "last_updated": "2013-11-18",
        "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": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar KenMar Pediatrics",
            "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 Nov 18, 2013; 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.