WELLSTAR MEDICAL GROUP, LLC (NPI# 1053617621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053617621 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR WOODLAWN COMMONS FAMILY PRACTICE |
| Practice Address |
1010 Johnson Ferry Rd Marietta GA 30068-2108 |
| Practice Telephone | 7709737302 |
| Practice Fax Number | 7709716692 |
| Mailing Telephone | 7709737302 |
| Mailing Fax Number | 7709716692 |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2013-11-19 |
| 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 | 207Q00000X | Family Medicine | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Woodlawn Commons Family Practice | 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 |
1010 JOHNSON FERRY RD |
| City | MARIETTA |
| State | GA |
| Zip Code | 30068-2108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649267444 | Darlene Mendenhall Coyne | Nurse Practitioner | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2005-10-05 |
| 1629423298 | Umme Safa Nur | Internal Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068 | 2016-05-02 |
| 1750666525 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2011-10-12 |
| 1194021733 | Wellstar Medical Group, LLC | Family Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2011-01-30 |
| 1003043324 | Yen-i Grace Chen | Family Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2009-06-12 |
| 1295829448 | Christine Mackenzie | Nurse Practitioner | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2006-10-03 |
| 1518914399 | Wellstar Woodlawn Commons Family Practice, LLC | Family Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2006-05-27 |
| 1033165535 | Wellstar East Cobb Medical Center, LLC | Family Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2006-05-26 |
| 1366415028 | Devender Reddy | Family Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2006-02-10 |
| 1962475152 | Jane Boyers | Nurse Practitioner | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2006-02-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831798917 | Barbara Ann Goldschmidt | Pharmacist | 4088 Lower Roswell Rd, Marietta, GA 30068 | 2020-10-20 |
| 1285274480 | Cory Plasker | Chiropractor | 519b Johnson Ferry Road, Suite 350, Marietta, GA 30068 | 2020-01-15 |
| 1952949893 | Dr Amy L Varner LLC | Internal Medicine | 1000 Johnson Ferry Rd Bldg E Ste 200, Marietta, GA 30068 | 2019-12-11 |
| 1417501834 | Cornerstone Hospice and Palliative Care of Georgia, LLC | Hospice Care, Community Based | 1225 Johnson Ferry Rd., Bldg. 100, Suite 160, Marietta, GA 30068 | 2019-07-25 |
| 1639721038 | Cayla Clark | Behavior Technician | 137 Johnson Ferry Road Suite 2170, Marietta, GA 30068 | 2019-07-15 |
| 1467910828 | 2me Healthcare,llc | Home Health | 2586 Club Valley Drive Ne, Marietta, GA 30068 | 2019-03-05 |
| 1265912604 | Feidy Chiropractic Clinic Inc, Dba Cardwell Chiropractic Clinic | Chiropractor | 1230 Johnson Ferry Pl Ste G30, Marietta, GA 30068 | 2018-08-15 |
| 1225514219 | Audrey Hughes. Lcsw, LLC | Clinic/Center | 1212 Johnson Ferry Rd, Suite 300, Marietta, GA 30068 | 2018-07-13 |
| 1316461379 | Evan King | Registered Nurse | 52 Pioneer Trl, Marietta, GA 30068 | 2017-08-01 |
| 1912431867 | Anthony Izore | Nurse Practitioner | 5163 Tall Oak Drive, Marietta, GA 30068 | 2017-04-18 |
| Find all providers in zip 30068 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053885327 | Clinica De La Salud Smyrna, Inc | Family Medicine | 1815 S Cobb Dr Se Ste 101, Marietta, GA 30060-4958 | 2019-01-19 |
| 1033689351 | H&h Weight Loss LLC | Family Medicine | 3600 Dallas Hwy Sw Ste 210, Marietta, GA 30064-1687 | 2018-11-29 |
| 1801380886 | Virginia Hinton | Family Medicine | 1738 Bertram Ln Sw, Marietta, GA 30008-4138 | 2018-06-21 |
| 1285145573 | Mitchell Scott Nudelman | Family Medicine | 577 Seminole Dr Ne, Marietta, GA 30060-1507 | 2017-10-13 |
| 1740649771 | Christine Morris | Family Medicine | 141 Lacy St Nw Ste 100, Marietta, GA 30060-1117 | 2016-02-18 |
| 1891110268 | Edith I. Okoi Chukwunyere | Family Medicine | 2337 Goodwood Dr Sw, Marietta, GA 30064-4335 | 2014-02-21 |
| 1629407549 | Candace M. Walker | Family Medicine | 3707 Largent Way, Well Star West Cobb Family Practice, Marietta, GA 30064 | 2013-11-01 |
| 1982959987 | Norman Glenn Marvin | Family Medicine | 4220 Lower Roswell Rd, Unit #7300, Marietta, GA 30068-4128 | 2012-07-17 |
| 1457626855 | Gena Marie Mastrogianakis | Family Medicine | 3595 Canton Rd Ste 116-289, Marietta, GA 30066-2658 | 2012-03-19 |
| 1710271010 | Roland Ngwang | Family Medicine | 2698 Foxglove Dr Sw, Marietta, GA 30064-4546 | 2011-06-03 |
| 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.