Organization
WELLSTAR MEDICAL GROUP, LLC
Active
Parent organization
WELLSTAR MEDICAL GROUP, LLC
Other names
WellStar KenMar Pediatrics
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
760 KENNESAW AVE NW, MARIETTA, GA 30060-6909
(770) 427-0183
(770) 427-0788
Mailing address
760 KENNESAW AVE NW, MARIETTA, GA 30060-6909
(770) 427-0183
(770) 427-0788
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
GA
Other
Enumeration date
02/08/2011
Last updated
11/18/2013
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