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WELLSTAR MEDICAL GROUP LLC NPI 1255637211


NPI Information

NPI: 1255637211
Provider Name: WELLSTAR MEDICAL GROUP, LLC

Doing Business As: WELLSTAR PEDIATRICS AT BROOKSTONE

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D0967015

Address:
5150 STILESBORO RD NW
SUITE 220
KENNESAW, GA
ZIP 30152
Phone: (770) 424-8222
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WELLSTAR MEDICAL GROUP, LLC is a pediatrics in Kennesaw, GA. The provider is 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. WELLSTAR MEDICAL GROUP, LLC NPI is 1255637211. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Wellstar Pediatrics At Brookstone.

The provider's business location address is:

5150 STILESBORO RD NW
SUITE 220
KENNESAW, GA
ZIP 30152-744
Phone: (770) 424-8222
Fax: (770) 424-9962

The provider's authorized official is Nicole Ashe .
The authorized official title is Executive Director Of Finance and has the following contact phone number (470) 644-0095.

The CLIA number assigned to this NPI record is 11D0967015 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/8/2011 and was last updated on 11/19/2013.


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
1208000000XPediatricsGEORGIAYes

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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