WELLSTAR MEDICAL GROUP, LLC (NPI# 1295031839) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295031839 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR COBB FAMILY MEDICINE |
| Practice Address |
1790 Mulkey Rd Suite 8-a Austell GA 30106-1122 |
| Practice Telephone | 7709441830 |
| Practice Fax Number | 7707390260 |
| Mailing Telephone | 7709441830 |
| Mailing Fax Number | 7707390260 |
| Enumeration Date | 2011-01-30 |
| 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 Cobb Family Medicine | 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 |
1790 MULKEY RD SUITE 8-A |
| City | AUSTELL |
| State | GA |
| Zip Code | 30106-1122 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225036015 | Kathy Mcknight Lockett | Nurse Practitioner | 1790 Mulkey Rd, Austell, GA 30106-1122 | 2005-07-14 |
| 1891340667 | Skitzy Joy Tobias | Nurse Practitioner | 1790 Mulkey Rd, Austell, GA 30106-1122 | 2019-08-07 |
| 1427485986 | Wellstar Medical Group, LLC | Otolaryngology | 1790 Mulkey Rd, Suite 7, Austell, GA 30106-1122 | 2013-09-30 |
| 1174870430 | West Atlanta Endodontics | Dentist | 1790 Mulkey Rd, Suite 2, Austell, GA 30106-1122 | 2012-08-06 |
| 1982900551 | Wellstar Medical Group, LLC | Otolaryngology | 1790 Mulkey Rd, Austell, GA 30106-1122 | 2011-01-31 |
| 1790081362 | Wellstar Medical Group, LLC | Internal Medicine | 1790 Mulkey Rd, Suite 5-a, Austell, GA 30106-1122 | 2011-01-31 |
| 1477878759 | Kelli Pitt | Internal Medicine | 1790 Mulkey Rd, Suite 5a, Austell, GA 30106-1122 | 2010-03-30 |
| 1952533382 | Sarah Cosci Baker | Audiologist-Hearing Aid Fitter | 1790 Mulkey Rd, Suite 7, Austell, GA 30106-1122 | 2009-08-18 |
| 1912107434 | David W Norrington | Dentist | 1790 Mulkey Rd, Suite 2, Austell, GA 30106-1122 | 2007-07-23 |
| 1194854901 | Arlita D Jackson | Dentist | 1790 Mulkey Rd, Bldg 4, Austell, GA 30106-1103 | 2007-03-05 |
| 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 | 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 |
|---|---|---|---|---|
| 1679045736 | Janda' Hill | Family Medicine | 5043 Ceylon Ct, Austell, GA 30106-2632 | 2018-12-28 |
| 1831622984 | Mali Khamissi Sobi | Family Medicine | 4787 Austell Rd, Austell, GA 30106-2001 | 2017-04-05 |
| 1992253322 | Community Holistic Advanced Practice Nurses (chapn) LLC | Family Medicine | 1707 N. Blairs Bridge Road, Austell, GA 30168-5537 | 2016-09-14 |
| 1790093524 | Saadia Ilyas | Family Medicine | 1605 Mulkey Rd Ste 220, Austell, GA 30106-1127 | 2010-09-14 |
| 1588703730 | Arnold Dollar Gaskin | Family Medicine | 1773 Sweetwater St, Austell, GA 30106-3294 | 2007-02-05 |
| 1164569158 | The Baxter Clinic | Family Medicine | 5914 Love St, Austell, GA 30168-4033 | 2007-01-31 |
| 1306907001 | Bonnie P Ellenoff | Family Medicine | 3640 Tramore Pointe Parkway, Sw, Kaiser Permanente West Cobb Medical Center, Austell, GA 30106 | 2006-12-13 |
| 1851486054 | Laura Alyce Makaroff | Family Medicine | 1850 E West Connector, Unit 221, Austell, GA 30106-1246 | 2006-10-04 |
| 1629089354 | Thi Minh Diem Nguyen | Family Medicine | 4426 Austell Rd, Austell, GA 30106-1844 | 2006-08-10 |
| 1538159603 | Thomas Gearhard | Family Medicine | 1790 Mulkey Rd Ste 8a, Austell, GA 30106-1122 | 2005-10-28 |
| 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.