| Organization Name: | WELLSTAR SURGICAL ASSOCIATES OF MARIETTA |
| NPI Number: | 1003235383 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANITA JOYCE JOHNSON (NURSE PRACTITIONER) |
| Mailing Address: | 55 Whitcher St Ne Ste 130 Marietta |
| State: | GA US |
| Postal Code: | 300601156 |
| Phone Number: | 7704280462 |
| Fax Number: | 7704280462 |
| NPI Enumeration Date: | 04/15/2014 |
| NPI Last Update Date: | 04/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | RN175391 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |