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General NPI Number Information
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NPI Number | 1235411547
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Entity Type | Organization
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Legal Business Name | WELLSTREET OF GEORGIA PC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 1825 HIGHWAY 34 E STE 1200
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City | NEWNAN
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State | GA
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Zip | 30265-6416
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Country | US
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Telephone | 770-502-2121
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Fax | 770-502-2113
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Provider Business Mailing Address
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Address Line | 3350 RIVERWOOD PKWY SE STE 1850
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City | ATLANTA
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State | GA
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Zip | 30339-3300
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Country | US
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Telephone | 404-996-0344
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Fax | 404-662-2399
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Authorized Official
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Title or Position | VICE PRESIDENT REVENUE CYCLE MANAGE
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Name | VICTORIA ELLISON
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Credential |
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Telephone | 770-502-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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