WELLSTAR MEDICAL GROUP, LLC (NPI# 1699065573) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699065573 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR TRAUMA |
| Practice Address |
55 Whitcher St Ne Suite 130 Marietta GA 30060-1156 |
| Practice Telephone | 7704261629 |
| Practice Fax Number | 7704278001 |
| Mailing Telephone | 7704261629 |
| Mailing Fax Number | 7704278001 |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2015-06-05 |
| 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 | 2086S0127X |
Surgery Specialization: Trauma Surgery |
GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Trauma | 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 |
55 WHITCHER ST NE SUITE 130 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1156 |
| 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 | 2086S0127X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Trauma Surgery |
| Trauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residency and usually continue with a one to two year fellowship in trauma and/or surgical critical care, typically leading to additional board certification in surgical critical care. There is no trauma surgery board certification at this point. To obtain board certification in surgical critical care, a fellowship in surgical critical care or anesthesiology critical care must be completed during or after general surgery residency. |
| Notes: Source: American Board of Surgery, 2007 [1/1/2008: definition added, source added] Additional Resources: http://www.absurgery.org/. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215248604 | James G Boron | Surgery | 55 Whitcher St Ne Ste 130, Marietta, GA 30060 | 2010-06-30 |
| 1700047784 | Keren Aviva Bashan-gilzenrat | Surgery | 55 Whitcher St Ne Ste 130, Marietta, GA 30060 | 2008-06-22 |
| 1184898223 | Nathan Michael Polite | Surgery | 55 Whitcher St Ne, Suite 130, Marietta, GA 30060-1155 | 2008-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205192424 | Nathan John Klingensmith | Surgery | 69 Jesse Hill Jr Drive, Se, Glenn Memorial Building, 3rd Floor, Atlanta, GA 30303 | 2012-04-03 |
| 1306928809 | Kevin J Farrell | Surgery | 101 West Ponce Deleon Ave, Emory Medical Care Foundation Ste 331, Decatur, GA 30030 | 2006-10-20 |
| 1972503837 | Gregory R Strauther | Surgery | 200 S Enota Dr Ne, Suite 150, Gainesville, GA 30501-3473 | 2005-07-21 |
| 1841583119 | Brian H Gibson | Surgery | 743 Spring St Ne, Gainesville, GA 30501-3715 | 2011-05-19 |
| 1710283460 | Malcolm Ingram Goodchild | Surgery | 2737 Warm Springs Rd, Building A, Columbus, GA 31904-6859 | 2011-01-28 |
| 1427377043 | James Clifton Haynes | Surgery | 2500 Hospital Blvd Ste 290, Roswell, GA 30076-4918 | 2010-05-21 |
| 1790946762 | Katherine Kohler | Surgery | 69 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3033 | 2008-06-22 |
| 1801062773 | Nathan Joseph Creel | Surgery | 743 Spring St Ne, Gainesville, GA 30501-3715 | 2008-05-01 |
| 1205021201 | Mitchell Chaar | Surgery | 80 Jesse Hill Jr Dr Se, Atlanta, GA 30303-3031 | 2007-09-12 |
| 1245456706 | Cassandra Quiana White | Surgery | 1120 15th St, Augusta, GA 30912-0004 | 2007-04-17 |
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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.