Organization
WELLSTREET OF GEORGIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA ALVORD (PRACTICE MANAGER)
(770) 521-6690
Entity
Organization
Contact information
Practice address
1575 MOUNT VERNON RD, DUNWOODY, GA 30338-4146
(404) 996-0197
(770) 730-9969
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
—
003135899A
—
GA
Enumeration date
04/12/2018
Last updated
04/12/2018
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