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WELLSTAR MEDICAL GROUP LLC NPI 1669767364


NPI Information

NPI: 1669767364
Provider Name: WELLSTAR MEDICAL GROUP, LLC

Doing Business As: WELLSTAR URGENT CARE AT COOPER LAKE

Classification: Clinic/Center - 261QU0200X
Entity Type: Organization

Specialization: Urgent Care

CLIA Number: 11D1062908

Address:
4480 N COOPER LAKE RD SE
SUITE 100
SMYRNA, GA
ZIP 30082
Phone: (770) 333-1300
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WELLSTAR MEDICAL GROUP, LLC is an urgent care clinic center in Smyrna, GA. WELLSTAR MEDICAL GROUP, LLC NPI is 1669767364. The provider is registered as an organization entity type.
The provider Is Doing Business As Wellstar Urgent Care At Cooper Lake.

The provider's business location address is:

4480 N COOPER LAKE RD SE
SUITE 100
SMYRNA, GA
ZIP 30082-622
Phone: (770) 333-1300
Fax: (770) 432-8312

The provider's authorized official is Nicole Ashe .
The authorized official title is Executive Director Of Finance and has the following contact phone number (770) 792-5261.

The CLIA number assigned to this NPI record is 11D1062908 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 6/10/2011 and was last updated on 6/10/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QU0200XClinic/CenterUrgent CareGEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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