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General NPI Number Information
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NPI Number | 1396233482
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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 | 04/25/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2118 SCENIC HWY N STE H
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City | SNELLVILLE
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State | GA
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Zip | 30078-6197
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Country | US
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Telephone | 770-558-6017
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Fax |
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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 |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | SAMANTHA ALVORD
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Credential |
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Telephone | 770-521-6690
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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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