WELLSTAR MEDICAL GROUP, LLC (NPI# 1972905396) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972905396 |
| Entity Type | Organization |
| Organization Name | WELLSTAR MEDICAL GROUP, LLC |
| Other Organization Name | WELLSTAR PEDIATRIC ANESTHESIA |
| Practice Address |
1180 Ernest W Barrett Pkwy Nw Suite 100 Kennesaw GA 30144-4534 |
| Practice Telephone | 7706441274 |
| Practice Fax Number | 7706441119 |
| Mailing Telephone | 7706441274 |
| Mailing Fax Number | 7706441119 |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-09-26 |
| 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 | 207LP3000X |
Anesthesiology Specialization: Pediatric Anesthesiology |
GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| WellStar Pediatric Anesthesia | 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 |
1180 ERNEST W BARRETT PKWY NW SUITE 100 |
| City | KENNESAW |
| State | GA |
| Zip Code | 30144-4534 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326064007 | Regina Frances Robbins | Pediatrics | 1180 Ernest W Barrett Pkwy Nw, Wellstar Medical Group LLC, Kennesaw, GA 30144-4534 | 2006-07-14 |
| 1245632660 | Wellstar Medical Group, LLC | Anesthesiology | 1180 Ernest W Barrett Pkwy Nw, Suite 100, Kennesaw, GA 30144-4534 | 2014-09-17 |
| 1457771925 | Wellstar Medical Group, LLC | Clinic/Center | 1180 Ernest W Barrett Pkwy Nw, Suite 102b, Kennesaw, GA 30144-4534 | 2014-04-23 |
| 1316382328 | Nicole Adriana Davidson | Pediatrics | 1180 Ernest W Barrett Pkwy Nw, Kennesaw, GA 30144-4534 | 2013-05-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205440054 | Physician Assistant Surgical Solutions | Surgery | 4290 Bells Ferry Road, Suite 134 - 1032, Kennesaw, GA 30144 | 2020-08-31 |
| 1487149340 | Creative Family Care Inc. | Social Worker | 1275 Shiloh Rd Nw Ste 3030, Kennesaw, GA 30144 | 2018-06-24 |
| 1033632203 | Octavio Andres Tobar | Specialist/Technologist | 1950 Barrett Lakes Blvd Nw Apt 1213, Kennesaw, GA 30144 | 2017-07-19 |
| 1851829220 | Sharon Mcmillan | Counselor | 1301 Shiloh Rd Nw Ste 1840, Kennesaw, GA 30144 | 2017-05-31 |
| 1073054680 | Metropolitan Health Care Plus Inc | Home Health | 445 Laurian Way, Kennesaw, GA 30144 | 2017-03-15 |
| 1649627969 | Caresouth Hha Holdings of Gainesville, LLC | Hospice Care, Community Based | 1000 Cobb Place Blvd Nw Ste 310, Kennesaw, GA 30144 | 2016-05-17 |
| 1851745988 | Joseph Mulligan | Social Worker | 1301 Shiloh Rd., Ste. 849, Kennesaw, GA 30144 | 2016-04-14 |
| 1629438601 | Youfit Health Clubs | Clinic/Center | 3895 Cherokee St Suite 100, Kennesaw, GA 30144 | 2016-03-03 |
| 1598156317 | Jodie Evans | Specialist | 1925 Vaughn Rd, Ste 200, Kennesaw, GA 30144 | 2015-02-16 |
| 1912302134 | Sleepmed Therapies, Inc. | Durable Medical Equipment & Medical Supplies | 1000 Cobb Place Blvd Nw Ste 510, Kennesaw, GA 30144 | 2014-10-30 |
| Find all providers in zip 30144 | ||||
| Taxonomy Code | 207LP3000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pediatric Anesthesiology |
| An anesthesiologist who has had additional skill and experience in and is primarily concerned with the anesthesia, sedation, and pain management needs of infants and children. A pediatric anesthesiologist generally provides services including the evaluation of complex medical problems in infants and children when surgery is necessary, planning and care for children before and after surgery, pain control, anesthesia and sedation for any procedures out of the operating room such as MRI, CT scan, and radiation therapy. |
| Notes: Source: American Academy of Pediatrics, www.aap.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265047450 | Osama Hamed Ibrahim Elazzouny | Anesthesiology | 1311 Bon Air Dr, Augusta, GA 30907-3238 | 2020-09-14 |
| 1114525003 | Emily Kowal | Anesthesiology | 1001 Johnson Fy Rd Ne, Atlanta, GA 30342-1605 | 2020-10-13 |
| 1245869551 | Kelsey Rae Bohm | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2020-04-07 |
| 1225458342 | Michael Craig Fiedorek | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2014-04-17 |
| 1750727814 | Amit Bhakta | Anesthesiology | 1001 Johnson Fy Rd Ne, Atlanta, GA 30342 | 2013-05-16 |
| 1912297938 | Laura Elizabeth Gilbertson | Anesthesiology | 1405 Clifton Rd Ne, Children's Healthcare of Atlanta, Atlanta, GA 30322-1060 | 2011-04-11 |
| 1174758742 | Andrea Dillard | Anesthesiology | 6335 Hospital Pkwy Ste 111, Johns Creek, GA 30097-1550 | 2009-05-26 |
| 1770718843 | Justin B Long | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2009-05-19 |
| 1912181819 | Vidya S Yalamanchili | Anesthesiology | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2007-12-27 |
| 1336349497 | Sara Habte | Anesthesiology | 1001 Johnson Ferry Rd Ne, Atlanta, GA 30342-1605 | 2007-07-18 |
| Find all providers with the same taxonomy | ||||
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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.