WELLSTAR MEDICAL GROUP, LLC (NPI# 1346624160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346624160 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR INTERNAL MEDICINE (AUSTELL) |
| Practice Address |
1605 Mulkey Rd Suite 220 Austell GA 30106-1127 |
| Practice Telephone | 7709482353 |
| Practice Fax Number | 7708198824 |
| Mailing Telephone | 7709482353 |
| Mailing Fax Number | 7708198824 |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |
| 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 | 207R00000X | Internal Medicine | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Internal Medicine (Austell) | 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 |
| 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 |
| 1922405729 | Wellstar Medical Group, LLC | Family Medicine | 11685 Alpharetta Hwy, Suite 300, Roswell, GA 30076-4910 | 2014-11-24 |
| Street Address |
1605 MULKEY RD SUITE 220 |
| City | AUSTELL |
| State | GA |
| Zip Code | 30106-1127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437265683 | Philip Rentz Rast | Urology | 1605 Mulkey Rd, Bldg 2, Suite 210, Austell, GA 30106-1127 | 2006-08-21 |
| 1003355249 | Kelsey Irene Fortier | Nurse Practitioner | 1605 Mulkey Rd, Suite 220, Austell, GA 30106-1127 | 2017-02-21 |
| 1821466509 | Wellstar Medical Group, LLC | Internal Medicine | 1605 Mulkey Rd, Suite 220, Austell, GA 30106-1127 | 2015-09-11 |
| 1720392947 | Horace Wayne Templeton | Family Medicine | 1605 Mulkey Rd, Suite 220, Austell, GA 30106-1127 | 2010-07-29 |
| 1508910597 | C. David Markle, M.d. P.C. | Internal Medicine | 1605 Mulkey Rd, Suite A, Austell, GA 30106-1127 | 2007-01-23 |
| 1821158759 | Amber H Driskell | Internal Medicine | 1605 Mulkey Rd, Suite 220, Austell, GA 30106-1127 | 2006-12-11 |
| 1689780835 | West Cobb Urology, PC | Urology | 1605 Mulkey Rd, Bldg 2, Suite 210, Austell, GA 30106-1127 | 2006-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073126231 | Courtney Lashune Dorsett | Nurse Practitioner | 1005 Cureton Drive, Austell, Austell, GA 30106 | 2020-08-27 |
| 1184240491 | Brian H Eves | Dietitian, Registered | 3972 Brantley Drive, Austell, GA 30106 | 2020-06-23 |
| 1669014486 | Jesse Mccoy | Registered Nurse | 3950 Austell Rd., Austell, GA 30106 | 2019-10-14 |
| 1427522820 | Envision Optics LLC | Optometrist | 1680 E West Connector, Austell, GA 30106 | 2019-01-18 |
| 1972042380 | Thomas Dental Group | Clinic/Center | 1133 East West Connector, Suite 120, Austell, GA 30106 | 2017-02-17 |
| 1245779792 | Colton Dental Group | Clinic/Center | 2495 East-west Connector, Ste 60, Austell, GA 30106 | 2017-02-16 |
| 1144691684 | Georgia Dental Professionals, PC | Dentist | 780 East West Connector Sw, Suite 108, Austell, GA 30106 | 2015-10-09 |
| 1285013714 | Ikeade Bello Alamu | Nurse Practitioner | 2870 Betula Drive, Austell, GA 30106 | 2015-05-29 |
| 1376922211 | Jessica Williams | Obstetrics & Gynecology | 1700 Hospital South Dr Ste 500, Austell, GA 30106 | 2015-05-26 |
| 1558799593 | Tonya Renee Baldwin | Speech-Language Pathologist | 4229 Brass Trl., Austell, GA 30106 | 2013-10-30 |
| Find all providers in zip 30106 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| 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 Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://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 |
|---|---|---|---|---|
| 1154487460 | Raymond H Wexler | Internal Medicine | 3875 Austell Road, Suite 303, Austell, GA 30106-1151 | 2006-12-29 |
| 1265413819 | Jose M Figueroa | Internal Medicine | 4444 Austell Road, Suite 100, Austell, GA 30106 | 2005-11-10 |
| 1366423519 | Rajnish Gujral | Internal Medicine | 3950 Austell Rd # 22, Austell, GA 30106-1121 | 2005-11-07 |
| 1326037821 | Ellis L Malone | Internal Medicine | 1680 Hospital South Dr, Austell, GA 30106-8110 | 2005-10-18 |
| 1619966116 | Juan Carlos Franco | Internal Medicine | 1680 Hospital South Drive, Austell, GA 30106 | 2005-10-18 |
| 1285626614 | Timothy R. Flynn | Internal Medicine | 1790 Mulkey Rd Ste 5a, Austell, GA 30106-1122 | 2005-08-22 |
| 1417951369 | Olatunde Idowu | Internal Medicine | 3950 Austell Rd, Box 22, Austell, GA 30106-1121 | 2005-06-09 |
| 1821466509 | Wellstar Medical Group, LLC | Internal Medicine | 1605 Mulkey Rd, Suite 220, Austell, GA 30106-1127 | 2015-09-11 |
| 1255744595 | Wellstar Medical Group, LLC | Internal Medicine | 3825 Medical Park Dr, Suite 100, Austell, GA 30106-6831 | 2014-06-04 |
| 1528322534 | Kristian Holmes Stodghill | Internal Medicine | 4040 Hospital West Dr, Austell, GA 30106 | 2012-06-25 |
| Find all providers in AUSTELL | ||||
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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.