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NPI Code Detail

MEDICARE: WELLSTAR CARDIOVASCULAR MEDICINE, LLC

MEDICARE: WELLSTAR CARDIOVASCULAR MEDICINE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0001XClinical Cardiac Electrophysiology Physician
2207RI0011XInterventional Cardiology Physician
3207RC0000XCardiovascular Disease Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427333293
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLSTAR CARDIOVASCULAR MEDICINE, LLC
Provider Business Mailing Address
First Line : 55 WHITCHER ST NE
Second Line : SUITE 350
City : MARIETTA
State : GA
Zip : 30060-1155
Country : US
Telephone Number : 770-424-6893
Fax Number : 770-528-9938
Provider Business Practice Location Address
First Line : 720 TRANSIT AVE
Second Line : SUITE 102
City : CANTON
State : GA
Zip : 30114-2540
Country : US
Telephone Number : 770-704-1955
Fax Number : 770-720-2388
Authorized Official
Title or Position : CJIEF CARDIOLOGY OFFICER
Name : DR. BARRY D MANGEL
Credential :
Telephone Number : 770-424-6893
Provider Enumeration Date : 10/12/2011
Last Update Date : 05/09/2012

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