WELLSTAR MEDICAL GROUP, LLC (NPI# 1073819124) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073819124 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR PEDIATRIC & ADOLESCENT CENTER |
| Practice Address |
1810 Mulkey Rd Suite 201 Austell GA 30106-1151 |
| Practice Telephone | 7708199262 |
| Practice Fax Number | 7708190597 |
| Mailing Telephone | 7708199262 |
| Mailing Fax Number | 7708190597 |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2013-11-18 |
| 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 | 208000000X | Pediatrics | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Pediatric & Adolescent Center | 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 |
1810 MULKEY RD SUITE 201 |
| City | AUSTELL |
| State | GA |
| Zip Code | 30106-1151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114928207 | Cascade Radiology Consultants, PC | Radiology | 1810 Mulkey Rd, Ste 103, Austell, GA 30106-1151 | 2005-08-10 |
| 1801434691 | Dartiss M Chevalier | Nurse Practitioner | 1810 Mulkey Rd, Austell, GA 30106-1151 | 2019-12-12 |
| 1831692110 | Anastacia P Modo | Nurse Practitioner | 1810 Mulkey Rd, Austell, GA 30106-1151 | 2018-03-13 |
| 1942740758 | Amanda Manuel | Nurse Practitioner | 1810 Mulkey Rd, Austell, GA 30106-1151 | 2017-02-27 |
| 1669927455 | Kwneshia Lawane Dorsey | Nurse Practitioner | 1810 Mulkey Rd, Austell, GA 30106-1151 | 2016-08-22 |
| 1013309327 | Amber Borders | Nurse Practitioner | 1810 Mulkey Rd, Suite 201, Austell, GA 30106-1151 | 2015-02-23 |
| 1083010201 | Nissi Family Medicine LLC | Family Medicine | 1810 Mulkey Rd, Suite 105, Austell, GA 30106-1151 | 2014-11-16 |
| 1336569524 | Delano St.aubyn Maxam Jr. | Physical Therapist | 1810 Mulkey Rd, Suite 101, Austell, GA 30106-1151 | 2014-04-26 |
| 1871910174 | Allison Leigh Cargal | Nurse Practitioner | 1810 Mulkey Rd, Suite 201, Austell, GA 30106-1151 | 2014-03-25 |
| 1225321235 | Wellstar Medical Group, LLC | Surgery | 1810 Mulkey Rd, Suite 105, Austell, GA 30106-1151 | 2011-05-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073126231 | Courtney Lashune Dorsett | Nurse Practitioner | 1005 Cureton Drive, Austell, Austell, GA 30106 | 2020-08-27 |
| 1184240491 | Brian H Eves | Dietitian, Registered | 3972 Brantley Drive, Austell, GA 30106 | 2020-06-23 |
| 1669014486 | Jesse Mccoy | Registered Nurse | 3950 Austell Rd., Austell, GA 30106 | 2019-10-14 |
| 1427522820 | Envision Optics LLC | Optometrist | 1680 E West Connector, Austell, GA 30106 | 2019-01-18 |
| 1972042380 | Thomas Dental Group | Clinic/Center | 1133 East West Connector, Suite 120, Austell, GA 30106 | 2017-02-17 |
| 1245779792 | Colton Dental Group | Clinic/Center | 2495 East-west Connector, Ste 60, Austell, GA 30106 | 2017-02-16 |
| 1144691684 | Georgia Dental Professionals, PC | Dentist | 780 East West Connector Sw, Suite 108, Austell, GA 30106 | 2015-10-09 |
| 1285013714 | Ikeade Bello Alamu | Nurse Practitioner | 2870 Betula Drive, Austell, GA 30106 | 2015-05-29 |
| 1376922211 | Jessica Williams | Obstetrics & Gynecology | 1700 Hospital South Dr Ste 500, Austell, GA 30106 | 2015-05-26 |
| 1558799593 | Tonya Renee Baldwin | Speech-Language Pathologist | 4229 Brass Trl., Austell, GA 30106 | 2013-10-30 |
| Find all providers in zip 30106 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083762025 | Kimberly N Hodge Spears | Pediatrics | 3640 Tramore Pointe Parkway Sw, Department of Pediatrics, Austell, GA 30106 | 2007-01-08 |
| 1205826500 | Shelly-ann Michela Salandy | Pediatrics | 1680 Mulkey Rd, Suite E, Austell, GA 30106-1118 | 2005-10-27 |
| 1760831069 | Neena Alex | Pediatrics | 3950 Austell Rd, Austell, GA 30106-1121 | 2016-06-07 |
| 1003176082 | Joli Ann Mccarthy | Pediatrics | 3950 Austell Rd, Austell, GA 30106-1121 | 2012-05-23 |
| 1184908188 | Children's Medical Associates, LLC | Pediatrics | 1680 Mulkey Rd, Suite E, Austell, GA 30106-1118 | 2011-10-10 |
| 1942527684 | Saira I Alimohamed | Pediatrics | 3950 Austell Rd # 22, Austell, GA 30106 | 2010-04-20 |
| 1508987793 | Ronnika C Harley | Pediatrics | 1810 Mulkey Rd, Suite 201, Austell, GA 30106-1151 | 2007-04-03 |
| 1083756894 | Kelly Solms Garrison | Pediatrics | 3950 Austell Rd # 22, Austell, GA 30106 | 2007-02-12 |
| 1376649871 | Jennifer N Vernon | Pediatrics | 1810 Mulkey Rd, Suite 201, Austell, GA 30106-1151 | 2006-09-15 |
| 1962443515 | Bonita L Brockman | Pediatrics | 2041 Mesa Valley Way, Ste 185, Austell, GA 30106 | 2006-06-08 |
| Find all providers in AUSTELL | ||||
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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.