WELLSTAR MEDICAL GROUP, LLC (NPI# 1720471931) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720471931 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR PEDIATRIC HOSPITAL MEDICINE |
| Practice Address |
677 Church St Ne Suite 100 P Marietta GA 30060-1101 |
| Practice Telephone | 4707938585 |
| Practice Fax Number | 4707931970 |
| Mailing Telephone | 4707938585 |
| Mailing Fax Number | 4707931970 |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-16 |
| 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 |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | GA | Allopathic & Osteopathic Physicians | |
| Y | 208M00000X | Hospitalist | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Pediatric Hospital Medicine | 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 |
| 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 |
677 CHURCH ST NE SUITE 100 P |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841285095 | Grace S Kim | Anesthesiology | 677 Church St Ne, Marietta, GA 30060-1101 | 2005-09-14 |
| 1205436425 | Lakesha Alexis | Nurse Practitioner | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-10-27 |
| 1710594080 | Terrence Helms | Nurse Anesthetist, Certified Registered | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-09-30 |
| 1063022481 | Laura Elliott | Registered Nurse | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-08-01 |
| 1346868908 | Megan Grace Zimmerman | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-07-10 |
| 1578180535 | Devon Potler-jack | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-06-25 |
| 1740802032 | Noelle Shaw | Anesthesiologist Assistant | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-05-11 |
| 1316567860 | Molly O'keeffe | Registered Nurse | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-04-24 |
| 1740800317 | Sara Roberts | Registered Nurse | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-04-23 |
| 1508486184 | Luke Bishop | Student in an Organized Health Care Education/Training Program | 677 Church St Ne, Marietta, GA 30060-1101 | 2020-04-23 |
| 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 | 208M00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Hospitalist |
| Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. |
| Notes: Source: American Society of Hospital Medicine, 2007. http://www.hospitalmedicine.org/ [7/1/2009: definition aded] Additional Resources: Hospitalist is a recognized fellowship specialty program offered by many medical institutions. There is no board certification for the specialty at this point. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407386345 | J J Norris | Hospitalist | 677 Church St Ne, Marietta, GA 30060-1101 | 2017-06-13 |
| 1427465053 | Kenia Marissa Samuel | Hospitalist | 401 Matthew St, Marietta, OH 45750-1635 | 2014-07-15 |
| 1437578929 | Kumudha Rajeswaran | Hospitalist | 401 Matthew St, Marietta, OH 45750-1635 | 2014-04-10 |
| 1962829119 | John Kalasky | Hospitalist | 401 Matthew St, Marietta, OH 45750-1635 | 2014-03-26 |
| 1487093647 | Niju Baby Narakathu | Hospitalist | 1106 Colegate Dr, Marietta, OH 45750-1323 | 2013-06-21 |
| 1841546025 | Yonnael B De La Rosa Holguin | Hospitalist | 401 Matthew St, Hospitalist Group, Marietta, OH 45750-1635 | 2012-07-25 |
| 1164784401 | Wendy B Brandan | Hospitalist | 401 Matthew St, Hospitalist Group, Marietta, OH 45750-1635 | 2012-06-12 |
| 1982982799 | Dipika Sharma | Hospitalist | 677 Church St Ne, Marietta, GA 30060 | 2011-07-27 |
| 1396033692 | Wellstar Medical Group, LLC | Hospitalist | 677 Church St Ne, Marietta, GA 30060-1101 | 2011-07-20 |
| 1124315890 | Zhaneta Dzmitryieva | Hospitalist | 677 Church St Ne, Marietta, GA 30060-1101 | 2011-07-01 |
| 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.