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General NPI Number Information
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NPI Number | 1477560340
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Entity Type | Organization
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Legal Business Name | WELLSTAR DOUGLAS SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 6002 PROFESSIONAL PARKWAY SUITE 260
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City | DOUGLASVILLE
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State | GA
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Zip | 30134
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Country | US
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Telephone | 770-942-4822
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Fax | 770-942-5311
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Provider Business Mailing Address
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Address Line | 6002 PROFESSIONAL PARKWAY SUITE 260
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City | DOUGLASVILLE
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State | GA
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Zip | 30134
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Country | US
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Telephone | 770-942-4822
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Fax | 770-942-5311
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF FINANCE
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Name | MS. NICOLE ASHE
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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