WELLSTAR MEDICAL GROUP, LLC (NPI# 1215330451) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215330451 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR TRANSPLANT SURGERY |
| Practice Address |
793 Sawyer Rd Marietta GA 30062-2222 |
| Practice Telephone | 4706440170 |
| Practice Fax Number | 7705630741 |
| Mailing Telephone | 4706440170 |
| Mailing Fax Number | 7705630741 |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |
| 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 | 204F00000X | Transplant Surgery | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Transplant Surgery | 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 |
793 SAWYER RD |
| City | MARIETTA |
| State | GA |
| Zip Code | 30062-2222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982970190 | Wellstar Clinical Partners Medicare Aco, LLC | Voluntary or Charitable | 793 Sawyer Rd, Marietta, GA 30062-2222 | 2012-04-02 |
| 1275068173 | Ebanga Agbor | Nurse Practitioner | 793 Sawyer Rd, Marietta, GA 30062-2222 | 2017-04-28 |
| 1134501422 | Wellstar Health System, LLC | Clinic/Center | 793 Sawyer Rd, Marietta, GA 30062-2222 | 2015-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578051 | Pamela D Kretzmer | Social Worker | 3855 Shallowford Road, Suite 420, Marietta, GA 30062 | 2020-11-03 |
| 1932714680 | Michelle Chambless | Physical Therapist | Team Rehabilitation Ga01, LLC, 1401 Johnson Ferry Road, Suite 340, Marietta, GA 30062 | 2020-09-10 |
| 1700408887 | Life University | Chiropractor | 1323 Roswell Road, Marietta, GA 30062 | 2020-05-12 |
| 1104451160 | Sno Healthcare Group | Clinic/Center | 2424 Roswell Rd Ste 120, Marietta, GA 30062 | 2020-03-10 |
| 1811536212 | Sandy Plains Dental Group, PC | Dentist | 3460 Sandy Plains Rd, Suite 240, Marietta, GA 30062 | 2020-01-02 |
| 1073159034 | Magdala Tulcie Jodesty-jackson | Social Worker | 4343 Shalloword Road, Building H, Suite 4 Lower Level, Marietta, GA 30062 | 2019-11-25 |
| 1598235178 | Matthew Driggers | Counselor | 4343 Shallowford Rd C2, Marietta, GA 30062 | 2018-11-27 |
| 1750895785 | Emily Grace Minday | Counselor | 4343 Shallowford Road Building C, Suite 1 Lower Level, Marietta, GA 30062 | 2017-11-29 |
| 1477072122 | Jason Lee Amos | Speech-Language Pathologist | 3660 Chestnut Ridge Court, Marietta, GA 30062 | 2017-09-13 |
| 1346761376 | Marian Pomaah Opoku-agyeman | Nurse Practitioner | 4661 Andrea Pointe, Marietta, GA 30062 | 2017-06-29 |
| Find all providers in zip 30062 | ||||
| Taxonomy Code | 204F00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Transplant Surgery |
| Definition to come. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891176251 | Octav Cristea | Transplant Surgery | 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322 | 2015-06-11 |
| 1679916704 | Arielle Cimeno | Transplant Surgery | 101 Woodruff Circle Wmb Suite 51505, Atlanta, GA 30322-0001 | 2013-04-08 |
| 1972848331 | John Peter Cole | Transplant Surgery | 1070 Powers Pl, Alpharetta, GA 30009-8396 | 2012-12-11 |
| 1316237423 | Rahul N Maheshwari | Transplant Surgery | 610 3rd St Ste 100, Macon, GA 31201-3293 | 2011-04-10 |
| 1083939391 | Robert Dana Gordon | Transplant Surgery | 520 Cameron Manor Way Nw, Atlanta, GA 30328-6202 | 2010-03-30 |
| 1851341614 | Christian Peter Larsen | Transplant Surgery | 101 Woodruff Cir, Ste 5105 Wmb, Atlanta, GA 30322 | 2006-05-11 |
| 1215993118 | Paul Lu Tso | Transplant Surgery | 101 Woodruff Circle, Room 5105 Wmb, Atlanta, GA 30322-0001 | 2006-04-21 |
| 1013971670 | Stuart J Knechtle | Transplant Surgery | 5105 Wmb, 101 Woodruff Circle, Atlanta, GA 30322-0001 | 2006-04-12 |
| 1972594109 | Nicole A Turgeon | Transplant Surgery | 1364 Clifton Rd Ne Dept Of, Atlanta, GA 30322-0002 | 2005-11-05 |
| 1265759963 | Clark David Kensinger | Transplant Surgery | 1968 Peachtree Rd Nw Bldg 775th, Atlanta, GA 30309-1281 | 2010-04-21 |
| 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.