Healthcare Provider Details

I. General information

NPI: 1568395283
Provider Name (Legal Business Name): WELLSTAR MLMC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 LEGACY PT
CLAYTON GA
30525-5354
US

IV. Provider business mailing address

793 SAWYER RD
MARIETTA GA
30062-2222
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-0401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOHN G KERNDL
Title or Position: EVP & CFO
Credential:
Phone: 470-644-0076