Healthcare Provider Details

I. General information

NPI: 1881620334
Provider Name (Legal Business Name): WELLSTAR ATLANTA MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CORPORATE CENTER DR SUITE 200
MORROW GA
30260-4180
US

IV. Provider business mailing address

1800 PARKWAY PL SE STE 500
MARIETTA GA
30067-8237
US

V. Phone/Fax

Practice location:
  • Phone: 770-968-6464
  • Fax: 770-968-6455
Mailing address:
  • Phone: 470-999-4981
  • Fax: 770-999-2489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNA
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberNA
License Number State

VIII. Authorized Official

Name: MR. ANTHONY J BUDZINSKI
Title or Position: EVP & CHIEF FINANCIAL OFFICER
Credential:
Phone: 470-644-0012