Wellstar Medical Group, LLC
Pediatrics in Kennesaw, GA. Organization (NPI-2).
NPI number1457771925
StatusActive
Last updated in NPPESJun 10, 2015
Details
- NPI
- 1457771925
- Entity type
- Organization (NPI-2)
- Legal business name
- Wellstar Medical Group, LLC
- Organization subpart
- Yes
- Enumeration date
- Apr 23, 2014
- Last updated
- Jun 10, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | – | GA | Yes |
| 261QU0200X | Clinic/Center, Urgent Care | – | GA |
Other names
- Wellstar Pediatric After Hours Care (Doing Business As)
Practice location
1180 Ernest W Barrett Pkwy NwSuite 102b
Kennesaw, GA 30144-4534
Phone 678-354-2273 · Fax 770-794-6837
Mailing address
1180 Ernest W Barrett Pkwy NwSuite 102b
Kennesaw, GA 30144-4534
Phone 678-354-2273 · Fax 770-794-6837
Authorized official
Nicole Ashe
Executive Director Of Finance
4706440095
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