WELLSTAR MEDICAL GROUP, LLC (NPI# 1790189983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790189983 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR COMPLEX CARE CLINIC |
| Practice Address |
355 Tower Rd Ne 1st Floor Marietta GA 30060-9408 |
| Practice Telephone | 4706440029 |
| Practice Fax Number | 7704990352 |
| Mailing Telephone | 4706440029 |
| Mailing Fax Number | 7704990352 |
| Enumeration Date | 2014-10-16 |
| Last Update Date | 2014-10-16 |
| 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 |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | GA | Allopathic & Osteopathic Physicians | |
| Y | 207RE0101X |
Internal Medicine Specialization: Endocrinology, Diabetes & Metabolism |
GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Complex Care Clinic | 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 |
355 TOWER RD NE 1ST FLOOR |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-9408 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003879925 | Howard E Borger | Ophthalmology | 355 Tower Rd Ne, Suite 100, Marietta, GA 30060-9408 | 2006-04-11 |
| 1740647312 | Christopher Cottle | Nurse Practitioner | 355 Tower Rd Ne, Suite 300, Marietta, GA 30060-9408 | 2016-01-27 |
| 1255637740 | Andrew Goodner | Physician Assistant | 355 Tower Rd Ne, Suite 300, Marietta, GA 30060-9408 | 2011-02-01 |
| 1912203555 | Wellstar Medical Group, LLC | Internal Medicine | 355 Tower Rd Ne, Suite 300, Marietta, GA 30060-9408 | 2011-01-30 |
| 1093954562 | Denise Lowman-kedzierski | Nurse Practitioner | 355 Tower Rd Ne, Suite 300, Marietta, GA 30060-9408 | 2009-02-06 |
| 1306061114 | Eca Optical, LLC | Eyewear Supplier (Equipment, not the service) | 355 Tower Rd Ne, Suite 100, Marietta, GA 30060-9408 | 2007-04-16 |
| 1104861699 | Cyrus Samai | Pediatrics | 355 Tower Rd Ne, Ste 204, Marietta, GA 30060-9408 | 2006-06-18 |
| 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 | 207RE0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Endocrinology, Diabetes & Metabolism |
| An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://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 |
|---|---|---|---|---|
| 1043288418 | Lloyd Damon Weddington | Internal Medicine | 3747 Roswell Rd Ste 216, Marietta, GA 30062-6227 | 2006-03-10 |
| 1295715027 | Elyse Wendy Glaser | Internal Medicine | 3633 Blake Ford Club Drive, Marietta, GA 30062 | 2006-01-18 |
| 1730179060 | Jean E Molinary | Internal Medicine | 625 Church Street Nw, Marietta, GA 30060-1155 | 2005-10-27 |
| 1295730638 | Jane Alano Cases | Internal Medicine | 701 Hildreth Ln, Marietta, OH 45750-1768 | 2005-06-14 |
| 1669752911 | Wellstar Medical Group, LLC | Internal Medicine | 3747 Roswell Rd Ne, Suite 212, Marietta, GA 30062-6215 | 2011-08-18 |
| 1366681751 | Sadeka Shahani | Internal Medicine | 625 Church St Ne, Marietta, GA 30060-1101 | 2009-02-09 |
| 1700958394 | Sona P Amin | Internal Medicine | 3939 Roswell Rd, Suite 110, Marietta, GA 30062-6251 | 2006-11-15 |
| 1982650511 | Nitin N. Mayur, Md D/b/a Wellstar Medical Specialists | Internal Medicine | 55 Whitcher St Ne, Suite 400, Marietta, GA 30060-1155 | 2006-05-25 |
| 1912997255 | Sharvari N Rangnekar | Internal Medicine | 625 Church Street Nw, Marietta, GA 30060-1155 | 2005-10-27 |
| 1265422505 | Seymour J Rosenbloom | Internal Medicine | 625 Church Street Nw, Marietta, GA 30060-1155 | 2005-10-27 |
| 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.