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General NPI Number Information
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NPI Number | 1376447961
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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 | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 1302 LAFAYETTE PKWY STE C
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City | LAGRANGE
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State | GA
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Zip | 30241-2611
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Country | US
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Telephone | 470-944-5290
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Fax | 470-944-5291
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Provider Business Mailing Address
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Address Line | 206 OXFORD RD
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City | NEW ALBANY
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State | MS
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Zip | 38652-3115
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Country | US
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Telephone | 662-534-2227
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | NATASHA HOWARD
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Credential |
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Telephone | 762-930-8572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NULL
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