MEDICARE: WELLSTAR MEDICAL GROUP, 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
1	207Q00000X	Family Medicine Physician		GA

General Provider Information

NPI Number	:	1942506654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSTAR MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	4550 COBB PARKWAY NORTH NW
Second Line	:	SUITE 201
City	:	ACWORTH
State	:	GA
Zip	:	30101-4180
Country	:	US
Telephone Number	:	770-974-4655
Fax Number	:	770-974-7534

Provider Business Practice Location Address
First Line	:	4550 COBB PARKWAY NORTH NW
Second Line	:	SUITE 201
City	:	ACWORTH
State	:	GA
Zip	:	30101-4180
Country	:	US
Telephone Number	:	770-974-4655
Fax Number	:	770-974-7534

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR OF FINANCE
Name	:	MRS. NICOLE ASHE
Credential	:
Telephone Number	:	470-644-0095

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	11/19/2013

Similar Medicare Providers

1255296976 — EMILY FOWLER
Practice Location Address:

4550 COBB PARKWAY NORTH NW
ACWORTH, GA
30101-4180

Practice Phone: 470-956-0050
Practice Fax:

1629133103 — DR. OSAGIE OSARUME OKUNDAYE MD
Practice Location Address:

4550 COBB PARKWAY NORTH NW , SUITE 213
ACWORTH, GA
30101-4180

Practice Phone: 770-974-8479
Practice Fax: 770-974-8710

1689796963 — MS. WENDY FOTOPOULOS MA
Practice Location Address:

4550 COBB PARKWAY NORTH NW
ACWORTH, GA
30101-4180

Practice Phone: 770-505-7190
Practice Fax: 770-793-7413

1962680991 — DANIEL JUDAH HOLTZ MD
Practice Location Address:

4550 COBB PARKWAY NORTH NW , SUITE #309B
ACWORTH, GA
30101-4180

Practice Phone: 770-917-6795
Practice Fax: 770-529-9077

1326333907 — WELLSTAR MEDICAL GROUP, LLC
Practice Location Address:

4550 COBB PARKWAY NW , SUITE 309-B
ACWORTH, GA
30101-4180

Practice Phone: 770-917-6795
Practice Fax: 770-529-9077

1033483458 — MR. BOBBY JOEL TREADWELL JR. PA-C
Practice Location Address:

4550 COBB PARKWAY NORTH NW , SUITE 309B
ACWORTH, GA
30101-4180

Practice Phone: 770-917-6795
Practice Fax: 770-529-9077

Directions to “WELLSTAR MEDICAL GROUP, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.