Healthcare Provider Details

I. General information

NPI: 1417935701
Provider Name (Legal Business Name): WELLSTAR HOMECARE BILLING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SANDY PLAINS RD
MARIETTA GA
30066-6340
US

IV. Provider business mailing address

805 SANDY PLAINS RD
MARIETTA GA
30066-6340
US

V. Phone/Fax

Practice location:
  • Phone: 770-792-1616
  • Fax: 770-792-1785
Mailing address:
  • Phone: 770-792-1616
  • Fax: 770-792-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE008449
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberPHRE008449
License Number StateGA

VIII. Authorized Official

Name: ANTHONY J BUDZINSKI
Title or Position: ACTING PRESIDENT AND CEO
Credential:
Phone: 770-792-7600