# WELLSTAR MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WELLSTAR MEDICAL GROUP, LLC
- **Other names:** WellStar Medical Specialists
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1629374681
- **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:** 625 CHURCH ST NE, MARIETTA, GA 30060-1101
- **Practice address phone:** (770) 422-2004
- **Practice address fax:** (770) 422-8465
- **Mailing address:** 625 CHURCH ST NE, MARIETTA, GA 30060-1101
- **Mailing address phone:** (770) 422-2004
- **Mailing address fax:** (770) 422-8465

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | GA | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | GA | Yes |

## Other

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