WELLSTAR MEDICAL GROUP, LLC (NPI# 1184990145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184990145 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR RADIATION ONCOLOGY |
| Practice Address |
320 Kennestone Hospital Blvd Suite Ll1 Marietta GA 30060-1161 |
| Practice Telephone | 7707937500 |
| Practice Fax Number | 7707937985 |
| Mailing Telephone | 7707937500 |
| Mailing Fax Number | 7707937985 |
| Enumeration Date | 2012-03-23 |
| 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 | 2085R0001X |
Radiology Specialization: Radiation Oncology |
GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Radiation Oncology | 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 |
320 KENNESTONE HOSPITAL BLVD SUITE LL1 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891784229 | Charles H Crabbe | Internal Medicine | 320 Kennestone Hospital Blvd, Suite 201, Marietta, GA 30060-1161 | 2005-10-18 |
| 1508479825 | Sarah Burzynski | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Marietta, GA 30060-1161 | 2020-08-26 |
| 1538519855 | Marisa Anne Jendras | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Suite 216, Marietta, GA 30060-1161 | 2016-06-17 |
| 1174982482 | Amy S Bradley | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Ste 216, Marietta, GA 30060-1161 | 2016-02-15 |
| 1548691389 | Andrea Paal | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Ste 107, Marietta, GA 30060-1161 | 2013-12-04 |
| 1881990455 | Wellstar Medical Group, LLC | Otolaryngology | 320 Kennestone Hospital Blvd, Suite 107, Marietta, GA 30060-1161 | 2011-01-31 |
| 1275834616 | Wellstar | Audiologist | 320 Kennestone Hospital Blvd, Suite 107, Marietta, GA 30060-1161 | 2010-11-16 |
| 1316263353 | Justin P Hart | Radiology | 320 Kennestone Hospital Blvd, Ll 1, Marietta, GA 30060-1161 | 2010-04-15 |
| 1427294966 | Romni Maudann Owens | Internal Medicine | 320 Kennestone Hospital Blvd, Suite 201, Marietta, GA 30060-1161 | 2009-01-06 |
| 1760527253 | Karen M Ferguson | Physician Assistant | 320 Kennestone Hospital Blvd, Suite Ll1, Marietta, GA 30060 | 2007-02-21 |
| 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 | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| 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 Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578613667 | Lorie L Hughes | Radiology | 320 Kennestone Hospital Blvd Ste Ll1, Marietta, GA 30060-1166 | 2007-01-11 |
| 1902292956 | Rohit Gunan Ganju | Radiology | 320 Kennestone Hospital Blvd Ste Ll1, Marietta, GA 30060-1166 | 2015-04-07 |
| 1245521905 | Olusola Obayomi-davies | Radiology | 320 Kennestone Hospital Blvd Ste Ll1, Marietta, GA 30060 | 2011-04-28 |
| 1316263353 | Justin P Hart | Radiology | 320 Kennestone Hospital Blvd, Ll 1, Marietta, GA 30060-1161 | 2010-04-15 |
| 1093865198 | Mark P Mclaughlin | Radiology | 320 Kennestone Hospital Blvd Ste Ll1, Marietta, GA 30060-1166 | 2007-01-11 |
| 1518905470 | Mark S Quinn | Radiology | 320 Kennestone Hospital Blvd, Suite Ll1, Marietta, GA 30060-1161 | 2006-06-03 |
| 1376541649 | Srini Vasan | Radiology | 400 Matthew St, Strecker Cancer Center, Marietta, OH 45750-1644 | 2005-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679199392 | Southern Rad Onc LLC | Radiology | 809 South Park Street, Carrollton, GA 30117 | 2020-06-18 |
| 1962910679 | American Professional Associates LLC | Radiology | 33 Upper Riverdale Rd Sw Ste 105, Riverdale, GA 30274-2642 | 2018-01-16 |
| 1003324187 | American Professional Associates LLC | Radiology | 1136 Cleveland Ave Ste 119, East Point, GA 30344-3618 | 2018-01-11 |
| 1316387137 | Rakendu Prakash Shukla | Radiology | 148 Bill Carruth Pkwy Ste Ll30, Hiram, GA 30141-3768 | 2013-06-25 |
| 1023301082 | Jolinta Lin | Radiology | The Emory Clinic Dept of Radiation Oncology, 1365 Clifton Road, Ne, Atlanta, GA 30322-0001 | 2011-05-25 |
| 1679739825 | Charles Reginald Woods IIi | Radiology | 275 Professional Ct, Suite B, Riverdale, GA 30274-2531 | 2008-08-06 |
| 1003086216 | Coastal Radiation Oncology Assoc. | Radiology | 2500 Starling St Ste 107, Brunswick, GA 31520-4266 | 2008-03-04 |
| 1275710899 | Shannon Tucker Kahn | Radiology | 639 Kimberly Ln Ne, Atlanta, GA 30306-2224 | 2008-01-25 |
| 1295924801 | Brian Wise Weaver | Radiology | 1355 Heatherland Dr Sw, Atlanta, GA 30331-7460 | 2007-10-19 |
| 1225245798 | John W Devine, Md, PC | Radiology | 209 Pendleton Dr, Valdosta, GA 31602-1729 | 2007-05-16 |
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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.