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NPI Code Detail

MEDICARE: WELLSTAR WEST COBB MEDICAL CENTER, LLC

MEDICARE: WELLSTAR WEST COBB 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
1208000000XPediatrics Physician
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1396791679
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLSTAR WEST COBB MEDICAL CENTER, LLC
Provider Business Mailing Address
First Line : 3707 LARGENT WAY NW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1672
Country : US
Telephone Number : 678-581-5729
Fax Number : 678-581-5719
Provider Business Practice Location Address
First Line : 3707 LARGENT WAY NW
Second Line :
City : MARIETTA
State : GA
Zip : 30064-1672
Country : US
Telephone Number : 678-581-5729
Fax Number : 678-581-5719
Authorized Official
Title or Position : EXECUTIVE DIRECTOR OF FINANCE
Name : NICOLE ASHE
Credential :
Telephone Number : 770-792-5261
Provider Enumeration Date : 05/26/2006
Last Update Date : 07/14/2008

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Directions to “WELLSTAR WEST COBB MEDICAL CENTER, LLC ” Practice Location

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