# WELLSTAR MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WELLSTAR MEDICAL GROUP, LLC
- **Other names:** WellStar Kennesaw State University Student Health Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1790100170
- **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:** 3215 CAMPUS LOOP RD NW, KENNESAW, GA 30144-3227
- **Practice address phone:** (470) 578-6531
- **Practice address fax:** (470) 578-9004
- **Mailing address:** 3215 CAMPUS LOOP RD NW, KENNESAW, GA 30144-3227
- **Mailing address phone:** (470) 578-6531
- **Mailing address fax:** (470) 578-9004

## Taxonomy

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

## Other

- **Enumeration date:** 02/21/2014
- **Last updated:** 05/27/2015