Organization
PAULDING MEDICAL CENTER
Active
Other names
WellStar Pharmacy Network Store #4
Organization subpart
No
Provider details
NPI number
Authorized official
T. MARK HANEY (SITE ADMINISTRATOR)
(770) 445-4411
Entity
Organization
Contact information
Practice address
600 W MEMORIAL DR, WELLSTAR PAULDING HOSPITAL, DALLAS, GA 30132-4117
(770) 443-4780
(770) 443-4782
Mailing address
WELLSTAR PAULDING HOSPITAL, 600 W. MEMORIAL DRIVE, DALLAS, GA 30132
(770) 443-4780
(770) 443-4782
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009764
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000001438B
—
GA
01
—
1161722
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/12/2011
Last updated
09/12/2011
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