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General NPI Number Information
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NPI Number | 1245009737
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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 | 12/26/2023
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 110 BANKS CROSSING DR STE 110
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City | COMMERCE
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State | GA
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Zip | 30529-6606
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Country | US
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Telephone | 762-244-5830
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Fax | 762-244-5310
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Provider Business Mailing Address
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Address Line | 110 BANKS CROSSING DR STE 110
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City | COMMERCE
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State | GA
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Zip | 30529-6606
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Country | US
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Telephone | 762-244-5830
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Fax | 762-244-5310
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | KATIE MONS
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Credential |
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Telephone | 678-414-2824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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