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General NPI Number Information
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NPI Number | 1841246337
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Entity Type | Organization
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Legal Business Name | WELLSTAR EAST PAULDING PEDIATRIC CENTER, LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 51 HIRAM DR BUILDING B
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City | HIRAM
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State | GA
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Zip | 30141-1844
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Country | US
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Telephone | 678-945-8300
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Fax | 770-445-2060
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Provider Business Mailing Address
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Address Line | 51 HIRAM DR BUILDING B
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City | HIRAM
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State | GA
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Zip | 30141-1844
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Country | US
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Telephone | 678-945-8300
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Fax | 770-445-2060
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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