WELLSTAR MEDICAL GROUP, LLC (NPI# 1669815817) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669815817 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR GYNECOLOGIC ONCOLOGY |
| Practice Address |
1700 Hospital South Dr Suite 102 Austell GA 30106-6810 |
| Practice Telephone | 7707926262 |
| Practice Fax Number | 6783981929 |
| Mailing Telephone | 7707926262 |
| Mailing Fax Number | 6783981929 |
| Enumeration Date | 2013-04-08 |
| 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 | 207VX0201X |
Obstetrics & Gynecology Specialization: Gynecologic Oncology |
GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Gynecologic Oncology | 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 |
1700 HOSPITAL SOUTH DR SUITE 102 |
| City | AUSTELL |
| State | GA |
| Zip Code | 30106-6810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215922299 | Michael Hardee | Internal Medicine | 1700 Hospital South Dr, Suite 409, Austell, GA 30106-6810 | 2005-09-15 |
| 1184284010 | West Cobb Specialty Pharmacy | Pharmacy | 1700 Hospital South Dr, Austell, GA 30106-6810 | 2019-06-13 |
| 1972017374 | Nicole Dubois Witt | Nurse Practitioner | 1700 Hospital South Dr, Austell, GA 30106-6810 | 2017-11-21 |
| 1861843815 | Kendra Chavis | Physician Assistant | 1700 Hospital South Dr, Suite #200, Austell, GA 30106-6810 | 2016-06-30 |
| 1285027649 | Karen Monica Sumner | Nurse Practitioner | 1700 Hospital South Dr, Suite 300, Austell, GA 30106-6810 | 2015-03-10 |
| 1962894576 | Hanger Prosthetics & Orthotics Inc | Durable Medical Equipment & Medical Supplies | 1700 Hospital South Dr, Suite 406, Austell, GA 30106-6810 | 2015-02-19 |
| 1790183499 | Yasmeen Girardeau | Nurse Practitioner | 1700 Hospital South Dr, Austell, GA 30106-6810 | 2014-12-11 |
| 1457766875 | Robin Christine Gohacki | Nurse Practitioner | 1700 Hospital South Dr, Suite 202, Austell, GA 30106-6810 | 2014-06-24 |
| 1053740340 | Emily A Goolsby | Advanced Practice Midwife | 1700 Hospital South Dr, Suite 500, Austell, GA 30106 | 2013-11-06 |
| 1487081105 | Michelle Lewis-austin | Nurse Practitioner | 1700 Hospital South Dr, Suite 502, Austell, GA 30106-6810 | 2013-09-27 |
| 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 | 207VX0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecologic Oncology |
| An obstetrician/gynecologist who provides consultation and comprehensive management of patients with gynecologic cancer, including those diagnostic and therapeutic procedures necessary for the total care of the patient with gynecologic cancer and resulting complications. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093776056 | Jeffrey F Hines | Obstetrics & Gynecology | 1700 Hospital South Dr, Suite 102, Austell, GA 30106-6810 | 2006-03-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174880223 | Ernest Washington Franklin IIi | Obstetrics & Gynecology | 1 Bookhaven Dr., Suite 400, Atlanta, GA 30319-3059 | 2012-04-13 |
| 1740579390 | Marian Symmes Johnson | Obstetrics & Gynecology | 682 Hemlock St Ste 210, Macon, GA 31201 | 2011-04-05 |
| 1912118324 | Namita Khanna | Obstetrics & Gynecology | 1365 A Clifton Rd, Building Aa, 4'th Floor, Atlanta, GA 30332-2200 | 2007-05-25 |
| 1417060112 | Ainsworth Gatewood Dudley | Obstetrics & Gynecology | 401 S Lee St, Americus, GA 31709-3917 | 2006-08-16 |
| 1265465140 | Evelyn A Reynolds | Obstetrics & Gynecology | 2500 Hospital Blvd Ste 410, Roswell, GA 30076 | 2006-07-07 |
| 1245260884 | Ira Robert Horowitz | Obstetrics & Gynecology | Department of Gynecology and Obstetrics, 1365 Clifton Road, N.e., Atlanta, GA 30322-0001 | 2006-07-03 |
| 1780650283 | Matthew O Burrell | Obstetrics & Gynecology | 759 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2006-02-24 |
| 1598750945 | William Edward Richards | Obstetrics & Gynecology | 5353 Reynolds St Ste 200, Savannah, GA 31405-6087 | 2005-09-13 |
| 1932191582 | Alan N Gordon | Obstetrics & Gynecology | 840 Pine St, Ste 760, Macon, GA 31201-2100 | 2005-08-19 |
| 1831699966 | Keianna S Haley | Obstetrics & Gynecology | 3240 Avalon Blvd, Conyers, GA 30013-6320 | 2018-02-15 |
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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.