WELLSTAR MEDICAL GROUP, LLC (NPI# 1407141088) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407141088 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR PEDIATRICS EC |
| Practice Address |
3747 Roswell Rd Ne Suite 201 Marietta GA 30062-6215 |
| Practice Telephone | 7705782868 |
| Practice Fax Number | 7709718499 |
| Mailing Telephone | 7705782868 |
| Mailing Fax Number | 7709718499 |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2015-06-08 |
| 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 Pediatrics 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 |
| 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 |
3747 ROSWELL RD NE SUITE 201 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30062-6215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255633004 | Wellstar Medical Group, LLC | Family Medicine | 3747 Roswell Rd Ne, Suite 216, Marietta, GA 30062-6234 | 2010-11-30 |
| 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 |
| 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 | 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 |
|---|---|---|---|---|
| 1073168522 | Richard Rhodes | Pediatrics | 2155 Post Oak Tritt Rd Ste 100, Marietta, GA 30062-1651 | 2019-08-01 |
| 1437718566 | Rahmath Althaf | Pediatrics | 300 Grand Manor Dr, Marietta, GA 30068-3688 | 2019-06-12 |
| 1841778081 | Sun Pediatrics LLC | Pediatrics | 2520 Windy Hill Rd Se Ste 104, Marietta, GA 30067 | 2018-07-31 |
| 1376075481 | Julia Johnson Lovin | Pediatrics | 1810 Baldwin Farms Dr, Marietta, GA 30068-1556 | 2017-03-28 |
| 1912244484 | Edgar Allen Vaughan Jr. | Pediatrics | 575 Saint Annes Rd Nw, Marietta, GA 30064-1441 | 2013-01-03 |
| 1104125764 | Alison G. Ball | Pediatrics | 1405 Franklin Gtwy Se, Marietta, GA 30067-8721 | 2011-03-22 |
| 1679885230 | Carrie Ann Stinson | Pediatrics | 677 Church St Ne # 100p, Marietta, GA 30060-1101 | 2010-07-11 |
| 1720273782 | Tina M Smith | Pediatrics | 310 E 8th St Ste 130, Marietta, OH 45750-3379 | 2007-09-12 |
| 1295939627 | Maren Elizabeth Bear | Pediatrics | 677 Church St Ne Ste 100p, Marietta, GA 30060 | 2007-06-11 |
| 1831236546 | Elizabeth Gouri Garrot | Pediatrics | 1880 West Oak Pkwy, Suite 101, Marietta, GA 30062 | 2007-01-31 |
| 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.