# WELLSTREET OF GEORGIA PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WELLSTREET OF GEORGIA PC
- **Other names:** Piedmont Urgent Care by Wellstreet
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063061315
- **Legal business name:** WELLSTREET OF GEORGIA PC
- **Authorized official:** KEESHA D. PINACLE CREDENTIALING (CRED MGR)
- **Authorized official phone:** (770) 809-3036

## Contact information

- **Practice address:** 1280 DOGWOOD DR SE, CONYERS, GA 30013-5046
- **Practice address phone:** (404) 994-4662
- **Practice address fax:** (404) 994-4663
- **Mailing address:** 3350 RIVERWOOD PKWY SE STE 1850, ATLANTA, GA 30339-3300
- **Mailing address phone:** (770) 809-3036
- **Mailing address fax:** (404) 662-2399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 09/10/2019
- **Last updated:** 09/10/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003137211A | — | GA |