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General NPI Number Information
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NPI Number | 1427004027
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Entity Type | Organization
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Legal Business Name | WELLSTAR MARIETTA FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 52 TOWER RD NE
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City | MARIETTA
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State | GA
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Zip | 30060-6977
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Country | US
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Telephone | 770-423-0895
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Fax | 770-429-8628
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Provider Business Mailing Address
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Address Line | 52 TOWER RD NE
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City | MARIETTA
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State | GA
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Zip | 30060-6977
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Country | US
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Telephone | 770-423-0895
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Fax | 770-429-8628
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF FINANCE
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Name | NICOLE AHSE
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Credential |
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Telephone | 770-792-5261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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