Organization
WELLSTAR MEDICAL GROUP, LLC
Active
Parent organization
WELLSTAR MEDICAL GROUP, LLC
Other names
WellStar Kennesaw State University Student Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
WELLSTAR MEDICAL GROUP, LLC
Authorized official
MRS. NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE)
(470) 644-0095
Entity
Organization
Contact information
Practice address
3215 CAMPUS LOOP RD NW, KENNESAW, GA 30144-3227
(470) 578-6531
(470) 578-9004
Mailing address
3215 CAMPUS LOOP RD NW, KENNESAW, GA 30144-3227
(470) 578-6531
(470) 578-9004
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
GA
Other
Enumeration date
02/21/2014
Last updated
05/27/2015
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