WELLSTAR CARDIOVASCULAR MEDICINE, LLC (NPI# 1770868531) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770868531 |
Entity Type | Organization |
Organization Name | WELLSTAR CARDIOVASCULAR MEDICINE, LLC |
Practice Address |
4900 Ivey Rd Nw Bldg 1800 Suite 1801 Acworth GA 30101-4001 |
Mailing Address |
55 Whitcher St Ne Suite 350 Marietta GA 30060-1155 |
Practice Telephone | 7709748479 |
Practice Fax Number | 7709748710 |
Mailing Telephone | 7704246893 |
Mailing Fax Number | 7705829938 |
Enumeration Date | 2011-10-12 |
Last Update Date | 2012-05-09 |
Authorized Official Name | DR. BARRY D MANGEL (CHIEF CARDIOLOGY OFFICER) |
Authorized Official Telephone | 7704246893 |
Is Organization Subpart | Y |
Parent Organization Name | WELLSTAR HEALTH SYSTEM, INC. |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207RC0001X |
Internal Medicine Specialization: Clinical Cardiac Electrophysiology |
Allopathic & Osteopathic Physicians | ||
N | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
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 |
1639454408 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 12 Sammy Mcghee Blvd, Suite 202, Jasper, GA 30143-7711 | 2011-10-12 |
1952686826 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 1700 Hospital South Dr, Suite 409, Austell, GA 30106-6810 | 2011-10-11 |
Street Address |
4900 IVEY RD NW BLDG 1800 SUITE 1801 |
City | ACWORTH |
State | GA |
Zip Code | 30101-4001 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609840511 | Lee Brian Brandt Jr. | Physician Assistant | 4900 Ivey Rd Nw, Suite 1826, Acworth, GA 30101-4001 | 2006-02-15 |
1689045353 | Wilma Blake Faulkner | Acupuncturist | 4900 Ivey Rd Nw, Suite 820, Acworth, GA 30101-4001 | 2015-10-07 |
1750759247 | Kyle J Payne | Physical Therapist | 4900 Ivey Rd Nw, Suite 1001, Acworth, GA 30101-4001 | 2015-09-14 |
1336539402 | Amira Shafey | Family Medicine | 4900 Ivey Rd Nw, Acworth, GA 30101-4001 | 2015-01-28 |
1689077562 | Wellstar Medical Group, LLC | Family Medicine | 4900 Ivey Rd Nw, Suite 1301, Acworth, GA 30101-4142 | 2014-10-06 |
1215339288 | Mollie Archer | Physical Therapist | 4900 Ivey Rd Nw, Building 1000 Suite 1001, Acworth, GA 30101-4001 | 2014-09-22 |
1144645383 | Shaniqua A Wright | Chiropractor | 4900 Ivey Rd Nw, Suite 820, Acworth, GA 30101-4001 | 2014-02-25 |
1750621892 | Patricia Helen Creel | Physical Therapist | 4900 Ivey Rd Nw, Suite 1001, Acworth, GA 30101-4001 | 2013-02-27 |
1720360969 | Maria Danielle Bartlett | Physical Therapist | 4900 Ivey Rd Nw, Suite 1001, Acworth, GA 30101-4001 | 2011-09-14 |
1811294846 | Anna K Corum | Physical Therapist | 4900 Ivey Rd Nw, Suite 1001, Acworth, GA 30101-4001 | 2011-02-28 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952931552 | A3j Incorporated | Registered Nurse | 3905 Cobb Pkwy Nw Ste 305, Acworth, GA 30101 | 2020-01-22 |
1043869852 | Sharron Leigh Lipscomb | Acupuncturist | 3661 Cedarcrest Rd Ste 320, Acworth, GA 30101 | 2019-09-05 |
1699322933 | Cowry Home Dialysis LLC | Durable Medical Equipment & Medical Supplies | 4450 Calibre Crossings Nw, Suite # 1122, Acworth, GA 30101 | 2019-08-21 |
1760979595 | Sandra Jeanetta Pugh | Counselor | 118 Clubhouse Crossing, Acworth, GA 30101 | 2018-04-17 |
1679926950 | Cindy Hatfield Fruits | Psychologist | 4839 N. Main Street, Acworth, GA 30101 | 2016-07-21 |
1396192563 | Philip Young | Specialist/Technologist | 4841 Lake Park Lane, Acworth, GA 30101 | 2016-05-18 |
1770960619 | Karen Fuller | Marriage & Family Therapist | 2487 Cedarcrest Rd Ste 722, Acworth, GA 30101 | 2015-04-29 |
1366830333 | Willard Hogan IIi | Physician Assistant | 1720 Mars Hill Rd Nw Ste 8-175, Acworth, GA 30101 | 2014-12-29 |
1386042083 | Sebastian Diaz Fischer | Chiropractor | 2639 Hickory Grove Rd, Suit 150, Ackworth, GA 30101 | 2014-12-11 |
1841699337 | J Chappell Md PC | Dermatology | 4450 Calibre Crossings, Suite 1208, Acworth, GA 30101 | 2014-08-20 |
Find all providers in zip 30101 |
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 |
---|---|---|---|---|
1629133103 | Osagie Osarume Okundaye | Internal Medicine | 4550 Cobb Parkway North Nw, Suite 213, Acworth, GA 30101-4180 | 2006-12-26 |
1447333554 | Olaniyi Olabode Osofisan | Internal Medicine | 3459 Acworth Due West Rd Nw, Suite 559, Acworth, GA 30101-5819 | 2006-10-23 |
1760565808 | N.w. Georgia Cardiology Clinic,p.c. | Internal Medicine | 3459 Acworth Due West Rd Nw, Suite 559, Acworth, GA 30101-5819 | 2006-10-23 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013571033 | Norihiko Kamioka | Internal Medicine | 1364 Clifton Rd Ne Ste D422, Atlanta, GA 30322-1059 | 2019-04-24 |
1992229884 | Medical Software, LLC | Internal Medicine | 3855 Pleasant Hill Rd Ste 350, Duluth, GA 30096-8093 | 2017-08-01 |
1215399456 | Raymond Mai | Internal Medicine | 1120 15th St # 6518, Augusta, GA 30912-1436 | 2016-03-27 |
1043684954 | Columbus Cardiology Associates, PC | Internal Medicine | 905 N Jackson St, Ste B, Americus, GA 31719-3089 | 2015-11-17 |
1649693045 | Avantgarde Consultants, Inc. | Internal Medicine | 10945 State Bridge Rd Ste 401-708, Alpharetta, GA 30022-8164 | 2014-01-22 |
1194153973 | Epic Group 8 | Internal Medicine | 760 Old Roswell Rd, Suite 114, Roswell, GA 30076-2279 | 2013-10-14 |
1982940987 | Southeastern Cardiovascular Associates LLC | Internal Medicine | 1076 Bermuda Run, Statesboro, GA 30458-0858 | 2012-12-19 |
1265798763 | Sulay Pankaj Patel | Internal Medicine | 101 Woodruff Circle Wmb 1013, Atlanta, GA 30322 | 2012-04-09 |
1073879573 | Ozlem Bilen | Internal Medicine | Emory University Cardiovascular, 101 Woodruff Circle, Wmb 3004, Atlanta, GA 30322-0001 | 2012-04-09 |
1962779611 | Cardiac Consultants of Central Georgia | Internal Medicine | 2024 Watson Blvd Bldg 1, Warner Robins, GA 31093-3624 | 2011-11-23 |
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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.