Healthcare Provider Details

I. General information

NPI: 1992751564
Provider Name (Legal Business Name): WELLSTAR DOUGLASVILLE MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 HOSPITAL DR
DOUGLASVILLE GA
30134-2266
US

IV. Provider business mailing address

8820 HOSPITAL DR
DOUGLASVILLE GA
30134-2266
US

V. Phone/Fax

Practice location:
  • Phone: 770-947-3000
  • Fax: 770-947-3012
Mailing address:
  • Phone: 770-947-3000
  • Fax: 770-947-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ASHE
Title or Position: EXECUTIVE DIRECTOR OF FINANCE
Credential:
Phone: 770-947-3000