Organization
WELLSTAR MEDICAL GROUP, LLC
Active
Parent organization
WELLSTAR MEDICAL GROUP, LLC
Other names
WellStar Pediatric Anesthesia
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
1180 ERNEST W BARRETT PKWY NW, SUITE 100, KENNESAW, GA 30144-4534
(770) 644-1274
(770) 644-1119
Mailing address
1180 ERNEST W BARRETT PKWY NW, SUITE 100, KENNESAW, GA 30144-4534
(770) 644-1274
(770) 644-1119
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
—
GA
Other
Enumeration date
09/17/2014
Last updated
09/26/2014
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