WELLSTAR MEDICAL GROUP, LLC (NPI# 1255633004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255633004 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR FAMILY MEDICINE EC |
| Practice Address |
3747 Roswell Rd Ne Suite 216 Marietta GA 30062-6234 |
| Practice Telephone | 7709732272 |
| Practice Fax Number | 7709739245 |
| Mailing Telephone | 7709732272 |
| Mailing Fax Number | 7709739245 |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2015-06-08 |
| Authorized Official Name | MRS. NICOLE ASHE (EXECUTIVE VP 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 | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Family Medicine EC | 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 |
| 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 |
| 1922405729 | Wellstar Medical Group, LLC | Family Medicine | 11685 Alpharetta Hwy, Suite 300, Roswell, GA 30076-4910 | 2014-11-24 |
| Street Address |
3747 ROSWELL RD NE SUITE 216 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30062-6234 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972907293 | Wellstar Medical Group, LLC | Anesthesiology | 3747 Roswell Rd Ne, Suite 311, Marietta, GA 30062-6227 | 2014-10-15 |
| 1043619489 | Wellstar Medical Group, LLC | Chiropractor | 3747 Roswell Rd Ne, Suite 311, Marietta, GA 30062-6227 | 2014-08-21 |
| 1669752911 | Wellstar Medical Group, LLC | Internal Medicine | 3747 Roswell Rd Ne, Suite 212, Marietta, GA 30062-6215 | 2011-08-18 |
| 1407141088 | Wellstar Medical Group, LLC | Pediatrics | 3747 Roswell Rd Ne, Suite 201, Marietta, GA 30062-6215 | 2011-06-13 |
| 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 | 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.