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WELLSTAR MEDICAL GROUP EAST PAULDING PEDIATRICS NPI 1396738381


NPI Information

NPI: 1396738381
Provider Name: WELLSTAR MEDICAL GROUP EAST PAULDING PEDIATRICS
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
51 HIRAM DR
HIRAM, GA
ZIP 30141
Phone: (678) 945-8300
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WELLSTAR MEDICAL GROUP EAST PAULDING PEDIATRICS is a specialist in Hiram, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. WELLSTAR MEDICAL GROUP EAST PAULDING PEDIATRICS NPI is 1396738381. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

51 HIRAM DR
HIRAM, GA
ZIP 30141-844
Phone: (678) 945-8300
Fax: (770) 445-2020

The provider's authorized official is Kelly Davillier .
The authorized official title is Physician and has the following contact phone number (678) 945-8320.

The enumeration date for this NPI number is 8/25/2005 and was last updated on 12/8/2011.


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
1174400000XSpecialist024912LOUISIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11899964650AMEDICAIDGEORGIA
21420565MEDICAIDLOUISIANA

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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