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General NPI Number Information
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NPI Number | 1518914399
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Entity Type | Organization
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Legal Business Name | WELLSTAR WOODLAWN COMMONS FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 1010 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30068-2108
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Country | US
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Telephone | 770-973-7302
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Fax | 770-971-6692
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Provider Business Mailing Address
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Address Line | 1010 JOHNSON FERRY RD
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City | MARIETTA
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State | GA
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Zip | 30068-2108
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Country | US
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Telephone | 770-973-7302
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Fax | 770-971-6692
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF FINANCE
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Name | 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 | 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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