WELLSTAR PROFESSIONAL SERVICES, LLC (NPI# 1518139195) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518139195 |
| Entity Type | Organization |
| Organization Name | WELLSTAR PROFESSIONAL SERVICES, LLC |
| Practice Address |
805 Sandy Plains Rd Wpg-cbo Marietta GA 30066-6340 |
| Practice Telephone | 7707925278 |
| Mailing Telephone | 7707925278 |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-07-14 |
| Authorized Official Name | NICOLE ASHE (EXECTUIVE DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 7707925261 |
| Is Organization Subpart | Y |
| Parent Organization Name | WELLSTAR HEALTH SYSTEM, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RI0200X |
Internal Medicine Specialization: Infectious Disease |
Allopathic & Osteopathic Physicians | ||
| N | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians |
| Street Address |
805 SANDY PLAINS RD WPG-CBO |
| City | MARIETTA |
| State | GA |
| Zip Code | 30066-6340 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417935701 | Wellstar Homecare Billing, LLC | Pharmacy | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2006-01-06 |
| 1275992240 | Wellstar Medical Group, LLC | Clinic/Center | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2016-02-18 |
| 1457743304 | Seibattu Kallon | Nurse Practitioner | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2015-03-02 |
| 1164796009 | Maria De Freitas | Physician Assistant | 805 Sandy Plains Rd, Wellstar Medical Group, Marietta, GA 30066-6340 | 2012-02-23 |
| 1043405905 | Sherlyne Sidney | Physical Therapist | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2007-09-12 |
| 1447442314 | Donald H Campbell | Surgery | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2007-08-15 |
| 1437219656 | Wellstar Health System, Inc. | Point of Service | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2006-12-11 |
| 1750489720 | Richard Hart | Internal Medicine | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2006-09-21 |
| 1215035548 | Marcia Lee Delk | Internal Medicine | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2006-09-20 |
| 1073591376 | Wellstar Home Health, LLC | Home Health | 805 Sandy Plains Rd, Marietta, GA 30066-6340 | 2006-01-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598253684 | Comfort Community Center, LLC | Skilled Nursing Facility | 2440 Sandy Plains Road, Blvd 21, Suite 100, Marietta, GA 30066 | 2018-04-25 |
| 1538681994 | Passionate Care | In Home Supportive Care | 1110 Renfro Ln., Marietta, GA 30066 | 2017-07-07 |
| 1437510443 | Steven Caras | Internal Medicine | 2682 Bonaire Terrace, Marietta, GA 30066 | 2016-03-18 |
| 1275918781 | Latifat Bolajoko Asemota | Nurse Practitioner | 410 Nottingham Dr, Marietta, GA 30066 | 2015-07-26 |
| 1497094205 | Changing Phases Behavioral Support, Inc | Internal Medicine | 3655 Canton Rd Ste 201, Marietta, GA 30066 | 2013-02-14 |
| 1659618916 | Alison Nicole Sims | Occupational Therapist | 2465 Canopy Drive, Marietta, GA 30066 | 2013-01-07 |
| 1790044907 | Antoine Jose Davenport | Massage Therapist | 4686 Jamerson Creek Dr, Marietta, GA 30066 | 2012-05-08 |
| 1174898548 | Angel Elizabeth Nofziger | Nurse Practitioner | 3750 Palladian Village Dr Ste 300, Marietta, GA 30066 | 2012-03-18 |
| 1912298019 | Nancy Jean Slack | Pharmacist | 2833 Canton Road, Marietta, GA 30066 | 2011-04-22 |
| 1336456078 | Mario B Miller Sr. | Chiropractor | 50 Barrett Parkway, Suite 3005#126, Marietta, GA 30066 | 2010-09-01 |
| Find all providers in zip 30066 | ||||
| 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.