WELLSTAR MEDICAL GROUP, LLC (NPI# 1912203050) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912203050 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR CREEKSIDE PEDIATRICS |
| Practice Address |
6095 Professional Pkwy Suite 100 Douglasville GA 30134-5607 |
| Practice Telephone | 7709202255 |
| Practice Fax Number | 7709209963 |
| Mailing Telephone | 7709202255 |
| Mailing Fax Number | 7709209963 |
| Enumeration Date | 2011-02-08 |
| 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 | 208000000X | Pediatrics | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Creekside Pediatrics | 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 |
6095 PROFESSIONAL PKWY SUITE 100 |
| City | DOUGLASVILLE |
| State | GA |
| Zip Code | 30134-5607 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316936305 | Asher B Galloway | Obstetrics & Gynecology | 6095 Professional Pkwy, Suite A210, Douglasville, GA 30134-5607 | 2005-10-21 |
| 1699164061 | Kathleen Gearhart | Nurse Practitioner | 6095 Professional Pkwy, Suite 100, Douglasville, GA 30134-5607 | 2015-01-22 |
| 1356631758 | Yassmin Ahmed Yousef | Pediatrics | 6095 Professional Pkwy, Suite 100, Douglasville, GA 30134-5607 | 2011-04-19 |
| 1083910046 | Wellstar Medical Group, LLC | Obstetrics & Gynecology | 6095 Professional Pkwy, Suite A-210, Douglasville, GA 30134-5607 | 2011-02-08 |
| 1790004042 | Denise L Adams | Registered Nurse | 6095 Professional Pkwy, Suite 100, Douglasville, GA 30134-5607 | 2010-05-26 |
| 1487886511 | Open Mri of Georgia, Inc | Radiology | 6095 Professional Pkwy, Suite 101b, Douglasville, GA 30134-5607 | 2009-08-24 |
| 1366672107 | Shannon Leigh Colvin | Advanced Practice Midwife | 6095 Professional Pkwy, Suite A210, Douglasville, GA 30134-5607 | 2009-07-14 |
| 1942482310 | Arbor Place Family Medicine | Internal Medicine | 6095 Professional Pkwy, Bldg B Suite 200, Douglasville, GA 30134-5607 | 2007-11-28 |
| 1972705598 | Kay E Thompson | Registered Nurse | 6095 Professional Pkwy, Suite 100, Douglasville, GA 30134-5607 | 2007-06-05 |
| 1396965547 | Rafiq M. El Hammali | Internal Medicine | 6095 Professional Pkwy, Suite B205, Douglasville, GA 30134-5607 | 2007-04-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851915631 | Lilian Pereira | Nurse Practitioner | Bethesda Medical Group, LLC, 9280 Hwy 5 - Suite D, Douglasville, GA 30134 | 2020-06-08 |
| 1548822901 | Sweet Resolve LLC | Nurse Practitioner | 4318 Ridge Rd, Ste 111 Pmb 1017, Douglasville, GA 30134 | 2019-07-05 |
| 1598328791 | Straight Street Life Center Inc | Case Manager/Care Coordinator | 12461 Veterans Memorial, Douglasville, GA 30134 | 2019-04-15 |
| 1174014930 | Caitlin Waldrip | Chiropractor | 8326a Office Park Dr., Douglasville, GA 30134 | 2018-05-28 |
| 1861901050 | Michelle Denise Winston | Licensed Practical Nurse | 6497 E Strickland, Douglasville, GA 30134 | 2017-09-20 |
| 1518335843 | Willis Anthony Rogers | Durable Medical Equipment & Medical Supplies | 7094 Rose Lake Circle, Douglasville, GA 30134 | 2015-09-03 |
| 1497135131 | Patricia Warren | Social Worker | 8317 Office Park Drive Ste.#e, Douglasville, GA 30134 | 2015-06-08 |
| 1457747321 | Kidz Rock Therapy Services, LLC | Occupational Therapist | 6732 West Spring Street, Douglasville, GA 30134 | 2015-04-08 |
| 1386068476 | Naa Y Oden | Psychologist | 4813 Ridge Rd Ste 111-639, Douglasville, GA 30134 | 2014-02-10 |
| 1467893271 | American Ems | Ambulance | 7240 Bankhead Hwy, Douglasville, GA 30134 | 2013-07-09 |
| Find all providers in zip 30134 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902068109 | An-phuong Thuy Le | Pediatrics | 6095 Professional Pkwy Ste 100, Douglasville, GA 30134-5607 | 2008-06-28 |
| 1366569485 | Bi-county Pediatrics | Pediatrics | 6128 Prestley Mill Rd Ste D, Douglasville, GA 30134-5622 | 2007-03-23 |
| 1831289842 | Cornerstone Pediatrics, Inc. | Pediatrics | 8601 Baldwin Pkwy, Suites 2a & 2b, Douglasville, GA 30134-5625 | 2006-10-13 |
| 1417914201 | Raju J Kulangara | Pediatrics | 6084 Professional Parkway, Suite A, Douglasville, GA 30134 | 2006-04-27 |
| 1598721649 | Candan Ozbek | Pediatrics | 9280 Highway 5, Ste A, Douglasville, GA 30134 | 2006-04-25 |
| 1639142003 | Alicia M Landry | Pediatrics | 6875 Douglas Blvd, Suite A, Douglasville, GA 30135 | 2006-02-08 |
| 1013908342 | Abolhassan Yamin | Pediatrics | 8503 Campbellton St, Douglasville, GA 30134-1822 | 2005-11-04 |
| 1407846744 | Marilyn B Kaufman | Pediatrics | 6095 Professional Parkway, Suite 100, Douglasville, GA 30134 | 2005-10-27 |
| 1699152918 | Netochukwu Okafor | Pediatrics | 8954 Hospital Dr, Douglasville, GA 30134-2272 | 2015-05-06 |
| 1861812588 | Shaleak Brown | Pediatrics | 6875 Douglas Blvd, Douglasville, GA 30135 | 2014-04-21 |
| Find all providers in DOUGLASVILLE | ||||
| City | DOUGLASVILLE |
| Zip Code | 30134 |
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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.