Organization
WELLSTREET OF GEORGIA PC
Active
Parent organization
WELLSTREET OF GEORGIA PC
Other names
Piedmont Urgent Care by Wellstreet
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLSTREET OF GEORGIA PC
Authorized official
KEESHA D. PINACLE CREDENTIALING (CRED MGR)
(770) 809-3036
Entity
Organization
Contact information
Practice address
1280 DOGWOOD DR SE, CONYERS, GA 30013-5046
(404) 994-4662
(404) 994-4663
Mailing address
3350 RIVERWOOD PKWY SE STE 1850, ATLANTA, GA 30339-3300
(770) 809-3036
(404) 662-2399
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003137211A
—
GA
Enumeration date
09/10/2019
Last updated
09/10/2019
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