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Organization
WELLSTAR MEDICAL GROUP, LLC
Active
Organization
WELLSTAR MEDICAL GROUP, LLC
Active
Parent organization
WELLSTAR MEDICAL GROUP, LLC
Other names
WellStar Family Medicine (Governors)
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Authorized official
MRS. NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE)
(470) 644-0095
Entity
Organization
Contact information
Practice address
4900 IVEY RD NW, SUITE 1301, ACWORTH, GA 30101-4142
(770) 975-9077
(770) 790-4964
Mailing address
4900 IVEY RD NW, SUITE 1301, ACWORTH, GA 30101-4142
(770) 975-9077
(770) 790-4964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
GA
Other
Enumeration date
10/06/2014
Last updated
05/28/2015
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