# 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:** 1891265773
- **Authorized official:** TONIA RANA DAVIS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (770) 809-3036

## Contact information

- **Practice address:** 1155 CONCORD RD SE STE 200, SMYRNA, GA 30080-4207
- **Practice address phone:** (770) 809-3036
- **Practice address fax:** (404) 662-2399
- **Mailing address:** 3350 RIVERWOOD PKWY SE STE 1850, ATLANTA, GA 30339-3300
- **Mailing address phone:** (770) 809-3036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 12/04/2018
- **Last updated:** 11/13/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003137211A | — | GA |