Healthcare Provider Details

I. General information

NPI: 1164388765
Provider Name (Legal Business Name): WELLSTARIS MEDICAL EQUIPMENT & SUPPLY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AUSTELL POWDER SPRINGS RD STE 265A-B
AUSTELL GA
30106-2427
US

IV. Provider business mailing address

5000 AUSTELL POWDER SPRINGS RD STE 265A-B
AUSTELL GA
30106-2427
US

V. Phone/Fax

Practice location:
  • Phone: 470-552-0841
  • Fax:
Mailing address:
  • Phone: 470-552-0841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LOLITA JOHNESE BURGESS
Title or Position: COO
Credential:
Phone: 225-436-1667