# WELLSTAR MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WELLSTAR MEDICAL GROUP, LLC
- **Other names:** WellStar North Douglas Ob/Gyn
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1083910046
- **Legal business name:** WELLSTAR MEDICAL GROUP, LLC
- **Authorized official:** MRS. NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE)
- **Authorized official phone:** (470) 644-0095

## Contact information

- **Practice address:** 6095 PROFESSIONAL PKWY, SUITE A-210, DOUGLASVILLE, GA 30134-5607
- **Practice address phone:** (770) 949-4188
- **Practice address fax:** (770) 949-1614
- **Mailing address:** 6095 PROFESSIONAL PKWY, SUITE A-210, DOUGLASVILLE, GA 30134-5607
- **Mailing address phone:** (770) 949-4188
- **Mailing address fax:** (770) 949-1614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | GA | Yes |

## Other

- **Enumeration date:** 02/08/2011
- **Last updated:** 11/18/2013