# WELLSTAR MEDICAL GROUP, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** KSU Student Health Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497616742
- **Authorized official:** MRS. CHHAVI NOOHANI DO (MEDICAL DIRECTOR)
- **Authorized official phone:** (470) 578-6644

## Contact information

- **Practice address:** 1000 TECHNOLOGY WAY SUITE 1107, MARIETTA, GA 30060
- **Practice address phone:** (470) 578-6644
- **Practice address fax:** (470) 578-9205
- **Mailing address:** 793 SAWYER ROAD, MARIETTA, GA 30062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1000X | Student Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/18/2025
- **Last updated:** 11/18/2025