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
120 STONEBRIDGE PKWY, SUITE 110, WOODSTOCK, GA 30189-3767
(678) 324-4400
(770) 528-9933
Mailing address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(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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