Organization
WELLSTAR CARDIOVASCULAR MEDICINE, LLC
Active
Organization
WELLSTAR CARDIOVASCULAR MEDICINE, LLC
Active
Parent organization
WELLSTAR HEALTH SYSTEM, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLSTAR HEALTH SYSTEM, INC.
Authorized official
DR. BARRY D MANGEL (CHIEF CARDIOLOGY OFFICER)
(770) 424-6893
Entity
Organization
Contact information
Practice address
1010 JOHNSON FERRY RD, MARIETTA, GA 30068-2108
(770) 321-3490
(770) 321-3489
Mailing address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 242-6893
(770) 528-9938
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
386693863A
—
GA
Enumeration date
10/12/2011
Last updated
05/09/2012
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