WELLSTAR MEDICAL GROUP, LLC (NPI# 1790100170) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790100170 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR KENNESAW STATE UNIVERSITY STUDENT HEALTH SERVICES |
| Practice Address |
3215 Campus Loop Rd Nw Kennesaw GA 30144-3227 |
| Practice Telephone | 4705786531 |
| Practice Fax Number | 4705789004 |
| Mailing Telephone | 4705786531 |
| Mailing Fax Number | 4705789004 |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2015-05-27 |
| 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 | 261QS1000X |
Clinic/Center Specialization: Student Health |
GA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| WellStar Kennesaw State University Student Health Services | 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 |
3215 CAMPUS LOOP RD NW |
| City | KENNESAW |
| State | GA |
| Zip Code | 30144-3227 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790776524 | Megan Elizabeth Bowles | Internal Medicine | 3215 Campus Loop Rd Nw, Kennesaw, GA 30144-3227 | 2005-11-01 |
| 1174077028 | Iliana I Vermillion | Nurse Practitioner | 3215 Campus Loop Rd Nw, Kennesaw, GA 30144-3227 | 2016-08-09 |
| 1184005761 | Chelsea Gonzalez | Family Medicine | 3215 Campus Loop Rd Nw, Kennesaw, GA 30144 | 2015-06-09 |
| 1497865901 | Caroline Didonato O'donnell | Nurse Practitioner | 3215 Campus Loop Rd Nw, Kennesaw, GA 30144-3227 | 2006-08-30 |
| 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 | 261QS1000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Student Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518207612 | Kennesaw State University | Clinic/Center | 1000 Chastain Rd Nw, Md5200 House 52, Kennesaw, GA 30144-5588 | 2013-02-26 |
| 1831426931 | Kennesaw State University Health Clinic | Clinic/Center | 1000 Chastain Rd Nw, House 52, Kennesaw, GA 30144-5588 | 2009-11-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023422417 | Georgia Southwestern State University | Clinic/Center | 800 Gsw University Drive, Americus, GA 31709 | 2014-06-13 |
| 1154758001 | Georgia College & State University | Clinic/Center | 120 W Campus Dr Cbx 091, Milledgeville, GA 31061-1990 | 2013-10-08 |
| 1831443936 | Georgia College & State University | Clinic/Center | 120 W Campus Dr, Cbx 091, Milledgeville, GA 31061-1990 | 2012-10-29 |
| 1821373580 | Thomas University | Clinic/Center | 1501 Millpond Rd, Thomasville, GA 31792-7478 | 2011-10-13 |
| 1215239934 | Aasu Sports Medicne | Clinic/Center | 11935 Abercorn St, Savannah, GA 31419-1909 | 2010-12-01 |
| 1396873527 | Georgia Institute of Technology | Clinic/Center | 740 Ferst Drive, Nw, Atlanta, GA 30332-0470 | 2007-03-01 |
| 1043352016 | Georgia Institute of Technology Stamps Health Services | Clinic/Center | 740 Ferst Drive, Atlanta, GA 30332-0470 | 2007-02-13 |
| 1891255519 | Alexander Clifford Commanday | Clinic/Center | 49 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3049 | 2019-03-20 |
| 1144629932 | Young Harris College | Clinic/Center | 1 College St, Young Harris, GA 30582-4137 | 2014-08-18 |
| 1811324296 | Columbus State University | Clinic/Center | 4225 University Ave, Athletics Lumpkin Center Rm 124, Columbus, GA 31907-5679 | 2013-10-01 |
| Find all providers with the same taxonomy | ||||
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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.