WELLSTAR CARDIOVASCULAR MEDICINE, LLC (NPI# 1457320319) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457320319 |
| Entity Type | Organization |
| Organization Name | WELLSTAR CARDIOVASCULAR MEDICINE, LLC |
| Practice Address |
55 Whitcher St Ne Suite 350 Marietta GA 30060-1155 |
| Practice Telephone | 7704246893 |
| Practice Fax Number | 7705289938 |
| Mailing Telephone | 7704246893 |
| Mailing Fax Number | 7705289938 |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2012-05-09 |
| Authorized Official Name | DR. BARRY D MANGEL (CHIEF CARDIOLOGY OFFICER) |
| Authorized Official Telephone | 7704246893 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | WELLSTAR HEALTH SYSTEM, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 386693863A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205195724 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 40 Fox Chase, Cartersville, GA 30120-2491 | 2012-05-04 |
| 1902183742 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 699 Church St Ne, Suite 240, Marietta, GA 30060-1110 | 2011-11-08 |
| 1992082739 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 700 Church St Ne, Marietta, GA 30060-7220 | 2011-11-08 |
| 1427333293 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 720 Transit Ave, Suite 102, Canton, GA 30114-2540 | 2011-10-12 |
| 1427333277 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 6001 Professional Pkwy, Suite 2080, Douglasville, GA 30134-5631 | 2011-10-12 |
| 1659656403 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 148 Bill Carruth Pkwy, Suite 100, Hiram, GA 30141-3754 | 2011-10-12 |
| 1750666525 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 1010 Johnson Ferry Rd, Marietta, GA 30068-2108 | 2011-10-12 |
| 1811272693 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 120 Stonebridge Pkwy, Suite 110, Woodstock, GA 30189-3767 | 2011-10-12 |
| 1770868531 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 4900 Ivey Rd Nw, Bldg 1800 Suite 1801, Acworth, GA 30101-4001 | 2011-10-12 |
| 1639454408 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 12 Sammy Mcghee Blvd, Suite 202, Jasper, GA 30143-7711 | 2011-10-12 |
| Street Address |
55 WHITCHER ST NE SUITE 350 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1155 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730183377 | Vijay Nath | Specialist | 55 Whitcher St Ne, Ste 460, Marietta, GA 30060-1171 | 2005-06-10 |
| 1710452875 | Jaleny Abajobir | Nurse Practitioner | 55 Whitcher St Ne, Marietta, GA 30060-1155 | 2018-10-04 |
| 1366961591 | Rachel Alexandra Strickland | Nurse Practitioner | 55 Whitcher St Ne, Marietta, GA 30060-1155 | 2017-09-19 |
| 1730609850 | Rudi Maria Coleman | Social Worker | 55 Whitcher St Ne, Marietta, GA 30060-1155 | 2017-06-20 |
| 1114451432 | Nerma S Mccrary | Nurse Practitioner | 55 Whitcher St Ne, Suite 460, Marietta, GA 30060-1155 | 2017-04-13 |
| 1215476304 | G | Nurse Practitioner | 55 Whitcher St Ne, Marietta, GA 30060-1155 | 2017-02-22 |
| 1972042117 | Joslyn Gross | Nurse Practitioner | 55 Whitcher St Ne, Ste 160, Marietta, GA 30060-1155 | 2017-02-21 |
| 1639616089 | Lonnie Jones | Nurse Practitioner | 55 Whitcher St Ne, Suite 130, Marietta, GA 30060-1155 | 2017-01-24 |
| 1073059804 | Melida Garcia | Nurse Practitioner | 55 Whitcher St Ne, Suite 350, Marietta, GA 30060-1155 | 2017-01-18 |
| 1528503166 | Helen W. James | Nurse Practitioner | 55 Whitcher St Ne, Suite 350, Marietta, GA 30060-1155 | 2017-01-05 |
| 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 | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972528040 | Jennifer M Jones | Internal Medicine | 400 Matthew St Ste 302, Marietta, OH 45750-1656 | 2006-07-12 |
| 1447291216 | Vineet Dua | Internal Medicine | 3747 Roswell Rd Ste 213, Marietta, GA 30062-6227 | 2006-06-10 |
| 1699721662 | Kennestone Heart Physicians Group | Internal Medicine | 355 Tower Road, Suite 300, Marietta, GA 30060 | 2006-05-25 |
| 1821066739 | Gregory L Simone | Internal Medicine | 604 Keeler Woods Dr Nw, Marietta, GA 30064-2064 | 2006-03-08 |
| 1285639641 | Joseph R Mayo | Internal Medicine | 400 Matthew St, Ste 302, Marietta, OH 45750-1644 | 2005-06-14 |
| 1336543529 | Wellstar Medical Group, LLC | Internal Medicine | 61 Whitcher St Ne, Suite 4100b, Marietta, GA 30060-1181 | 2014-10-16 |
| 1386064962 | Joshua Randall Clevenger | Internal Medicine | 400 Matthew St Ste 302, Marietta, OH 45750-1656 | 2014-04-22 |
| 1306178256 | Motaz Moussa | Internal Medicine | 400 Matthew St, Suite 302, Marietta, OH 45750-1644 | 2010-02-03 |
| 1548496433 | Kennestone Heart Physicians Group, PC | Internal Medicine | 1230 Johnson Ferry Pl, Suite B-10, Marietta, GA 30068-2048 | 2009-06-05 |
| 1538303409 | Richard A Bardack | Internal Medicine | 55 Whitcher St Ne, Suite 350, Marietta, GA 30060-1155 | 2009-04-22 |
| 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.