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General NPI Number Information
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NPI Number | 1760420228
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Entity Type | Organization
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Legal Business Name | WELLSTAR INTERNAL MEDICINE AT PAULDING, LLC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 290 MERCHANTS SQ SUITE F
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City | DALLAS
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State | GA
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Zip | 30132-5029
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Country | US
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Telephone | 678-363-9225
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Fax | 678-363-7916
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Provider Business Mailing Address
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Address Line | 290 MERCHANTS SQ SUITE F
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City | DALLAS
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State | GA
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Zip | 30132-5029
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Country | US
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Telephone | 678-363-9225
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Fax | 678-363-7916
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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