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Organization

WELLSTREET OF GEORGIA PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TONIA R DAVIS (CREDENTIALING MANAGER)
(770) 809-3036
Entity
Organization

Contact information

Practice address
1825 HIGHWAY 34 E STE 1200, NEWNAN, GA 30265-6416
(770) 502-2121
(770) 502-2113
Mailing address
549 BULLSBORO DR, NEWNAN, GA 30265-1045
(770) 502-2121

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary

Other

Enumeration date
11/06/2015
Last updated
12/02/2019
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