# WELLSTREET OF GEORGIA PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Piedmont Urgentcare by Wellstreet
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861980955
- **Authorized official:** SAMANTHA ALVORD (PRACTICE MANAGER)
- **Authorized official phone:** (770) 521-6690

## Contact information

- **Practice address:** 4763 ATLANTA HWY STE 420, LOGANVILLE, GA 30052-6788
- **Practice address phone:** (470) 395-6793
- **Mailing address:** 3350 RIVERWOOD PKWY SE STE 1850, ATLANTA, GA 30339-3300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 04/25/2018
- **Last updated:** 06/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003179873A | — | GA |