WELLSTAR MEDICAL GROUP, LLC (NPI# 1356736250) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356736250 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR SAFEPATH CHILDRENS ADVOCACY CENTER |
| Practice Address |
736 Whitlock Ave Nw Suite 600 Marietta GA 30064-0001 |
| Practice Telephone | 7708013465 |
| Practice Fax Number | 7708013465 |
| Mailing Telephone | 7708013465 |
| Mailing Fax Number | 7708013465 |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2015-09-30 |
| 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 | 2080C0008X |
Pediatrics Specialization: Child Abuse Pediatrics |
GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar SafePath Childrens Advocacy Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1922405729 | Wellstar Medical Group, LLC | Family Medicine | 11685 Alpharetta Hwy, Suite 300, Roswell, GA 30076-4910 | 2014-11-24 |
| Street Address |
736 WHITLOCK AVE NW SUITE 600 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30064-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043833304 | Chelsey Lewis | Pharmacist | 660 Whitlock Ave Sw, Marietta, GA 30064 | 2020-05-21 |
| 1316428527 | Candice Murray | Nurse Practitioner | 2727 Wynford Ave Sw, Marietta, GA 30064 | 2018-08-25 |
| 1427539741 | Emily Dorsey Drew | Nurse Practitioner | 3911 Mary Eliza Trce Nw Ste 200, Marietta, GA 30064 | 2018-08-24 |
| 1649765017 | Julie K Berger | Counselor | 336 Powder Springs St Suite 206, Marietta, GA 30064 | 2018-06-27 |
| 1689175291 | Anthony Bammer | Clinical Exercise Physiologist | 1001 Whitlock Avenue Nw, Marietta, GA 30064 | 2018-02-28 |
| 1831600725 | Dyniecia Barnes | Specialist | 2575 White Haven Dr Sw, Ste 100 / Salon 121, Marietta, GA 30064 | 2017-10-18 |
| 1588173298 | Michelle Ann Stich | Assistant Behavior Analyst | 376 Powder Springs St Ste 130, Marietta, GA 30064 | 2017-09-26 |
| 1194241976 | Namasine Lolice Dalrymple | Counselor | 1708 Peachtree St, Suite 300, Atlanta, GA 30064 | 2017-08-14 |
| 1245760859 | Michael H Mulkey, Dmd PC | Dentist | 3951 Mary Eliza Trace Nw, Suite 200, Marietta, GA 30064 | 2017-06-15 |
| 1700310893 | West Cobb Dentist Office, PC | Dentist | 3805 Dallas Hwy Sw, Suite 804, Marietta, GA 30064 | 2017-04-14 |
| Find all providers in zip 30064 | ||||
| Taxonomy Code | 2080C0008X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Child Abuse Pediatrics |
| A Child Abuse Pediatrician serves as a resource to children, families and communities by accurately diagnosing abuse; consulting with community agencies on child safety; providing expertise in courts of law; treating consequences of abuse and neglect; directing child abuse and neglect prevention programs and participating on multidisciplinary teams investigating; and managing child abuse cases. |
| Notes: Source: American Board of Medical Specialties, 2009 [7/1/2009: definition added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295996312 | Tamika J Bryant | Pediatrics | 1001 Johnson Ferry Rd Ne, Mob Suite 500, Atlanta, GA 30342-1605 | 2008-06-20 |
Please comment or provide details below to improve the information on WELLSTAR MEDICAL GROUP, LLC.
| 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.