WELLSTAR MEDICAL GROUP, LLC (NPI# 1245632660) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245632660 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR ANESTHESIA |
| Practice Address |
1180 Ernest W Barrett Pkwy Nw Suite 100 Kennesaw GA 30144-4534 |
| Practice Telephone | 7706441274 |
| Practice Fax Number | 7706441119 |
| Mailing Telephone | 7706441274 |
| Mailing Fax Number | 7706441119 |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-09-26 |
| Authorized Official Name | MRS. NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 4706440095 |
| Is Organization Subpart | Y |
| Parent Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207L00000X | Anesthesiology | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Anesthesia | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356736250 | Wellstar Medical Group, LLC | Pediatrics | 736 Whitlock Ave Nw, Suite 600, Marietta, GA 30064-0001 | 2015-03-30 |
| 1326333907 | Wellstar Medical Group, LLC | Surgery | 4550 Cobb Parkway Nw, Suite 309-b, Acworth, GA 30101-4180 | 2011-06-13 |
| 1255633004 | Wellstar Medical Group, LLC | Family Medicine | 3747 Roswell Rd Ne, Suite 216, Marietta, GA 30062-6234 | 2010-11-30 |
| 1639533896 | Wellstar Medical Group, LLC | Surgery | 8954 Hospital Dr, Douglasville, GA 30134-2272 | 2016-04-13 |
| 1275992240 | Wellstar Medical Group, LLC | Clinic/Center | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2016-02-18 |
| 1821466509 | Wellstar Medical Group, LLC | Internal Medicine | 1605 Mulkey Rd, Suite 220, Austell, GA 30106-1127 | 2015-09-11 |
| 1346624160 | Wellstar Medical Group, LLC | Internal Medicine | 1605 Mulkey Rd, Suite 220, Austell, GA 30106-1127 | 2015-07-10 |
| 1588059653 | Wellstar Medical Group, LLC | Family Medicine | 12 Medical Dr Ne, Cartersville, GA 30121-8002 | 2015-04-05 |
| 1720471931 | Wellstar Medical Group, LLC | Pediatrics | 677 Church St Ne, Suite 100 P, Marietta, GA 30060-1101 | 2015-03-12 |
| 1811380025 | Wellstar Medical Group, LLC | Psychiatry & Neurology | 780 Canton Rd Ne, Suite 400, Marietta, GA 30060-7298 | 2015-03-12 |
| Street Address |
1180 ERNEST W BARRETT PKWY NW SUITE 100 |
| City | KENNESAW |
| State | GA |
| Zip Code | 30144-4534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326064007 | Regina Frances Robbins | Pediatrics | 1180 Ernest W Barrett Pkwy Nw, Wellstar Medical Group LLC, Kennesaw, GA 30144-4534 | 2006-07-14 |
| 1972905396 | Wellstar Medical Group, LLC | Anesthesiology | 1180 Ernest W Barrett Pkwy Nw, Suite 100, Kennesaw, GA 30144-4534 | 2014-09-17 |
| 1457771925 | Wellstar Medical Group, LLC | Clinic/Center | 1180 Ernest W Barrett Pkwy Nw, Suite 102b, Kennesaw, GA 30144-4534 | 2014-04-23 |
| 1316382328 | Nicole Adriana Davidson | Pediatrics | 1180 Ernest W Barrett Pkwy Nw, Kennesaw, GA 30144-4534 | 2013-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205440054 | Physician Assistant Surgical Solutions | Surgery | 4290 Bells Ferry Road, Suite 134 - 1032, Kennesaw, GA 30144 | 2020-08-31 |
| 1487149340 | Creative Family Care Inc. | Social Worker | 1275 Shiloh Rd Nw Ste 3030, Kennesaw, GA 30144 | 2018-06-24 |
| 1033632203 | Octavio Andres Tobar | Specialist/Technologist | 1950 Barrett Lakes Blvd Nw Apt 1213, Kennesaw, GA 30144 | 2017-07-19 |
| 1851829220 | Sharon Mcmillan | Counselor | 1301 Shiloh Rd Nw Ste 1840, Kennesaw, GA 30144 | 2017-05-31 |
| 1073054680 | Metropolitan Health Care Plus Inc | Home Health | 445 Laurian Way, Kennesaw, GA 30144 | 2017-03-15 |
| 1649627969 | Caresouth Hha Holdings of Gainesville, LLC | Hospice Care, Community Based | 1000 Cobb Place Blvd Nw Ste 310, Kennesaw, GA 30144 | 2016-05-17 |
| 1851745988 | Joseph Mulligan | Social Worker | 1301 Shiloh Rd., Ste. 849, Kennesaw, GA 30144 | 2016-04-14 |
| 1629438601 | Youfit Health Clubs | Clinic/Center | 3895 Cherokee St Suite 100, Kennesaw, GA 30144 | 2016-03-03 |
| 1598156317 | Jodie Evans | Specialist | 1925 Vaughn Rd, Ste 200, Kennesaw, GA 30144 | 2015-02-16 |
| 1912302134 | Sleepmed Therapies, Inc. | Durable Medical Equipment & Medical Supplies | 1000 Cobb Place Blvd Nw Ste 510, Kennesaw, GA 30144 | 2014-10-30 |
| Find all providers in zip 30144 | ||||
| Taxonomy Code | 207L00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an operation or an obstetric or diagnostic procedure. The anesthesiologist assesses the risk of the patient undergoing surgery and optimizes the patient's condition prior to, during and after surgery. In addition to these management responsibilities, the anesthesiologist provides medical management and consultation in pain management and critical care medicine. Anesthesiologists diagnose and treat acute, long-standing and cancer pain problems; diagnose and treat patients with critical illnesses or severe injuries; direct resuscitation in the care of patients with cardiac or respiratory emergencies, including the need for artificial ventilation; and supervise post-anesthesia recovery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912452939 | Mak Anesthesia Holdings LLC | Anesthesiology | 1300 Ridenour Blvd., Ste. 300, Kennesaw, GA 30152 | 2016-08-19 |
| 1386028744 | Mak Anesthesia, LLC | Anesthesiology | 1621 N Roberts Rd Nw Ste 110, Kennesaw, GA 30144-3640 | 2015-07-16 |
| 1437579042 | James Michael Ditolla | Anesthesiology | 1275 Shiloh Rd Nw Ste 2120, Kennesaw, GA 30144-7199 | 2014-04-22 |
| 1558672782 | Isabella Zita Ricketts | Anesthesiology | 1300 Ridenour Blvd Nw, Mak Anesthesia, Kennesaw, GA 30152-4501 | 2010-06-22 |
| 1376785600 | Grant Adam Doornbos | Anesthesiology | 1300 Ridenour Blvd Nw Ste 300, Kennesaw, GA 30152-4402 | 2009-04-01 |
| 1609390103 | Mak Anesthesia Northside Affiliates, LLC | Anesthesiology | 1300 Ridenour Blvd Nw Ste 300, Kennesaw, GA 30152-4402 | 2017-07-27 |
| 1417402942 | Sculptrx Inc | Anesthesiology | 125 Townpark Dr Nw, Ste 300, Kennesaw, GA 30144-5803 | 2016-08-25 |
| 1699041863 | Jerry Tee Todd | Anesthesiology | 1300 Ridenour Blvd Nw Ste 300, Kennesaw, GA 30152-4402 | 2012-03-31 |
| 1013046374 | Russell H Blocker | Anesthesiology | 1640 Airport Rd Nw, Ste. 110, Kennesaw, GA 30144-7038 | 2007-03-05 |
| 1245369784 | Jenny R Deforeest | Anesthesiology | 1640 Airport Rd Nw, Ste. 110, Kennesaw, GA 30144-7038 | 2007-03-02 |
| Find all providers in KENNESAW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.