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NPI Code Detail

MEDICARE: WELLSTAR POWDER SPRINGS MEDICAL CENTER, LLC

MEDICARE: WELLSTAR POWDER SPRINGS MEDICAL CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1184671273
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLSTAR POWDER SPRINGS MEDICAL CENTER, LLC
Provider Business Mailing Address
First Line : 4250 BROWNSVILLE RD
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-2559
Country : US
Telephone Number : 678-567-8000
Fax Number : 770-439-3555
Provider Business Practice Location Address
First Line : 4250 BROWNSVILLE RD
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-2559
Country : US
Telephone Number : 678-567-8000
Fax Number : 770-439-3555
Authorized Official
Title or Position : EXECUTIVE DIRECTOR OF FINANCE
Name : NICOLE ASHE
Credential :
Telephone Number : 770-792-5261
Provider Enumeration Date : 05/27/2006
Last Update Date : 07/14/2008

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1093011603 — WELLSTAR MEDICAL GROUP, LLC
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Directions to “WELLSTAR POWDER SPRINGS MEDICAL CENTER, LLC ” Practice Location

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