Organization
WELLSTAR MEDICAL GROUP, LLC
Active
Parent organization
WELLSTAR MEDICAL GROUP, LLC
Other names
WellStar Cardiovascular Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Authorized official
MRS. NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE)
47064400953
Entity
Organization
Contact information
Practice address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1129
(770) 424-6893
(770) 528-9938
Mailing address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1129
(770) 424-6893
(770) 528-9938
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
GA
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
GA
207RI0011X
Interventional Cardiology Physician
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140302A
—
GA
Enumeration date
06/11/2013
Last updated
05/28/2015
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