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NPI Code Detail

MEDICARE: WELLSTREET OF GEORGIA PC

MEDICARE: WELLSTREET OF GEORGIA PC
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
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1326552118
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLSTREET OF GEORGIA PC
Provider Business Mailing Address
First Line : 3350 RIVERWOOD PKWY SE STE 1850
Second Line :
City : ATLANTA
State : GA
Zip : 30339-3300
Country : US
Telephone Number : 770-809-3036
Fax Number :
Provider Business Practice Location Address
First Line : 882 PONCE DE LEON AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4268
Country : US
Telephone Number : 770-809-3034
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : BRANDY CARTER
Credential :
Telephone Number : 404-996-0344
Provider Enumeration Date : 12/01/2017
Last Update Date : 12/01/2017

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Directions to “WELLSTREET OF GEORGIA PC ” Practice Location

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