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General NPI Number Information
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NPI Number | 1275992240
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Entity Type | Organization
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Legal Business Name | WELLSTAR MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1800 PARKWAY PL SE
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City | MARIETTA
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State | GA
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Zip | 30067-8200
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Country | US
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Telephone | 470-267-2433
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 742322
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City | ATLANTA
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State | GA
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Zip | 30374-2322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP/CFO
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Name | MR. MAXWELL KAGAN
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Credential |
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Telephone | 470-644-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | GA
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