Organization
WELLSTAR MEDICAL GROUP EAST PAULDING PEDIATRICS
Active
Parent organization
WELLSTAR MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLSTAR MEDICAL GROUP
Authorized official
DR. KELLY DAVILLIER MD (PHYSICIAN)
(678) 945-8320
Entity
Organization
Contact information
Practice address
51 HIRAM DR, HIRAM, GA 30141-1844
(678) 945-8300
(770) 445-2020
Mailing address
51 HIRAM DR, HIRAM, GA 30141-1844
(678) 945-8300
(770) 445-2020
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
024912
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1420565
—
LA
05
—
1899964650A
—
GA
Enumeration date
08/25/2005
Last updated
12/08/2011
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