WELLSTAR MEDICAL GROUP, LLC (NPI# 1881990455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881990455 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR PHYSICIANS GROUP ENT |
| Practice Address |
320 Kennestone Hospital Blvd Suite 107 Marietta GA 30060-1161 |
| Practice Telephone | 7707937613 |
| Practice Fax Number | 7707937413 |
| Mailing Telephone | 7707937613 |
| Mailing Fax Number | 7707937413 |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2011-01-31 |
| Authorized Official Name | MRS. NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 7707925261 |
| Is Organization Subpart | Y |
| Parent Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Physicians Group ENT | 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 |
320 KENNESTONE HOSPITAL BLVD SUITE 107 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891784229 | Charles H Crabbe | Internal Medicine | 320 Kennestone Hospital Blvd, Suite 201, Marietta, GA 30060-1161 | 2005-10-18 |
| 1508479825 | Sarah Burzynski | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Marietta, GA 30060-1161 | 2020-08-26 |
| 1538519855 | Marisa Anne Jendras | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Suite 216, Marietta, GA 30060-1161 | 2016-06-17 |
| 1174982482 | Amy S Bradley | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Ste 216, Marietta, GA 30060-1161 | 2016-02-15 |
| 1548691389 | Andrea Paal | Genetic Counselor, MS | 320 Kennestone Hospital Blvd, Ste 107, Marietta, GA 30060-1161 | 2013-12-04 |
| 1184990145 | Wellstar Medical Group, LLC | Radiology | 320 Kennestone Hospital Blvd, Suite Ll1, Marietta, GA 30060-1161 | 2012-03-23 |
| 1275834616 | Wellstar | Audiologist | 320 Kennestone Hospital Blvd, Suite 107, Marietta, GA 30060-1161 | 2010-11-16 |
| 1316263353 | Justin P Hart | Radiology | 320 Kennestone Hospital Blvd, Ll 1, Marietta, GA 30060-1161 | 2010-04-15 |
| 1427294966 | Romni Maudann Owens | Internal Medicine | 320 Kennestone Hospital Blvd, Suite 201, Marietta, GA 30060-1161 | 2009-01-06 |
| 1760527253 | Karen M Ferguson | Physician Assistant | 320 Kennestone Hospital Blvd, Suite Ll1, Marietta, GA 30060 | 2007-02-21 |
| 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 | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| 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 Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417103557 | David Michael Weeks | Otolaryngology | 699 Church St, Ste 340, Marietta, GA 30060 | 2008-08-08 |
| 1619933249 | Seth A Yellin | Otolaryngology | 111 Marble Mill Rd Nw, Marietta, GA 30060-1047 | 2006-04-22 |
| 1538145263 | Richard Alan Gunovich | Otolaryngology | 800 Wayne St Ste 112, Marietta, OH 45750-3309 | 2005-12-15 |
| 1518958552 | David Parks | Otolaryngology | 699 Church St Ne Ste 340, Marietta, GA 30060 | 2005-10-31 |
| 1912996422 | Lawrence Steven Weiss | Otolaryngology | 3901 Roswell Rd, Ste 225, Marietta, GA 30062-8816 | 2005-10-18 |
| 1093717688 | Andrew Everett Sutton | Otolaryngology | 780 Canton Rd Ne, Suite 330, Marietta, GA 30060-7241 | 2005-08-12 |
| 1790786911 | Drew Matthew Locandro | Otolaryngology | 80 Lacy St Nw, Northwest Ent and Allergy Center, Marietta, GA 30060 | 2005-08-10 |
| 1629075833 | Donald W Alexander | Otolaryngology | 833 Campbell Hill Street, Suite 420, Marietta, GA 30060-1138 | 2005-07-01 |
| 1720083702 | Roberto A. Larrivey | Otolaryngology | 790 Church St Ne, Ste 140, Marietta, GA 30060-8902 | 2005-06-16 |
| 1780688051 | Patrick Melder | Otolaryngology | 699 Church St Ne, Ste 340, Marietta, GA 30060 | 2005-06-02 |
| 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.