Organization
WELLSTREET OF GEORGIA PC
Active
Organization
WELLSTREET OF GEORGIA PC
Active
Other names
Piedmont Urgentcare by Wellstreet
Organization subpart
No
Provider details
NPI number
Authorized official
TONIA RANA DAVIS (CREDENTIALING COORDINATOR)
(770) 809-3036
Entity
Organization
Contact information
Practice address
1155 CONCORD RD SE STE 200, SMYRNA, GA 30080-4207
(770) 809-3036
(404) 662-2399
Mailing address
3350 RIVERWOOD PKWY SE STE 1850, ATLANTA, GA 30339-3300
(770) 809-3036
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003137211A
—
GA
Enumeration date
12/04/2018
Last updated
11/13/2019
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