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General NPI Number Information
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NPI Number | 1750242806
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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 | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 3752 CASCADE RD SW STE 110
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City | ATLANTA
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State | GA
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Zip | 30331-2148
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Country | US
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Telephone | 470-327-9870
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Fax | 470-327-9890
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Provider Business Mailing Address
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Address Line | 3752 CASCADE RD SW STE 110
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City | ATLANTA
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State | GA
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Zip | 30331-2148
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Country | US
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Telephone | 470-327-9870
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Fax | 470-327-9890
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | KATIE MONS
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Credential |
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Telephone | 770-502-2121
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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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