WELLSTAR MEDICAL GROUP, LLC (NPI# 1336543529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336543529 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR STRUCTURAL HEART CLINIC |
| Practice Address |
61 Whitcher St Ne Suite 4100b Marietta GA 30060-1181 |
| Practice Telephone | 7705904180 |
| Practice Fax Number | 7705904186 |
| Mailing Telephone | 7705904180 |
| Mailing Fax Number | 7705904186 |
| Enumeration Date | 2014-10-16 |
| Last Update Date | 2015-01-15 |
| 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 | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Structural Heart Clinic | 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 |
61 WHITCHER ST NE SUITE 4100B |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1181 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124014568 | Richard W Cohen | Orthopaedic Surgery | 61 Whitcher St Ne, Suite 1100, Marietta, GA 30060-1176 | 2005-09-21 |
| 1376050955 | Gina M Soto | Nurse Practitioner | 61 Whitcher St Ne, Marietta, GA 30060-1176 | 2018-01-04 |
| 1477062594 | Anna Swanson Bouchard | Nurse Practitioner | 61 Whitcher St Ne, Marietta, GA 30060-1176 | 2017-09-20 |
| 1396281200 | Trevor J Wallace | Physician Assistant | 61 Whitcher St Ne, Suite 1100, Marietta, GA 30060-1176 | 2017-01-17 |
| 1720537327 | Taylor Dellinger | Nurse Practitioner | 61 Whitcher St Ne, Suite 3110, Marietta, GA 30060-1176 | 2016-09-25 |
| 1164871117 | Georgiana Massad | Physician Assistant | 61 Whitcher St Ne, Suite 2100, Marietta, GA 30060-1176 | 2016-06-10 |
| 1134593809 | Sarah Applegarth | Physician Assistant | 61 Whitcher St Ne, Suite 2100, Marietta, GA 30060-1176 | 2015-11-18 |
| 1346660198 | Catherine Chmiel | Nurse Practitioner | 61 Whitcher St Ne, Suite 4100, Marietta, GA 30060-1176 | 2014-04-20 |
| 1467885863 | Wellstar Medical Group, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 61 Whitcher St Ne, Suite 4100, Marietta, GA 30060-1176 | 2013-08-21 |
| 1306186705 | Jon Barry Stanley | Physician Assistant | 61 Whitcher St Ne, Suite 4120, Marietta, GA 30060-1176 | 2013-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972528040 | Jennifer M Jones | Internal Medicine | 400 Matthew St Ste 302, Marietta, OH 45750-1656 | 2006-07-12 |
| 1447291216 | Vineet Dua | Internal Medicine | 3747 Roswell Rd Ste 213, Marietta, GA 30062-6227 | 2006-06-10 |
| 1699721662 | Kennestone Heart Physicians Group | Internal Medicine | 355 Tower Road, Suite 300, Marietta, GA 30060 | 2006-05-25 |
| 1821066739 | Gregory L Simone | Internal Medicine | 604 Keeler Woods Dr Nw, Marietta, GA 30064-2064 | 2006-03-08 |
| 1285639641 | Joseph R Mayo | Internal Medicine | 400 Matthew St, Ste 302, Marietta, OH 45750-1644 | 2005-06-14 |
| 1386064962 | Joshua Randall Clevenger | Internal Medicine | 400 Matthew St Ste 302, Marietta, OH 45750-1656 | 2014-04-22 |
| 1306178256 | Motaz Moussa | Internal Medicine | 400 Matthew St, Suite 302, Marietta, OH 45750-1644 | 2010-02-03 |
| 1548496433 | Kennestone Heart Physicians Group, PC | Internal Medicine | 1230 Johnson Ferry Pl, Suite B-10, Marietta, GA 30068-2048 | 2009-06-05 |
| 1538303409 | Richard A Bardack | Internal Medicine | 55 Whitcher St Ne, Suite 350, Marietta, GA 30060-1155 | 2009-04-22 |
| 1285877274 | Kennestone Heart Physicians Group, PC | Internal Medicine | 2513 Shallowford Rd, Building 100, Marietta, GA 30066-6809 | 2009-04-07 |
| Find all providers in MARIETTA | ||||
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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.