| Organization Name: | WELLSTAR MEDICAL GROUP, LLC |
| NPI Number: | 1013202712 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE) |
| Mailing Address: | 2890 Delk Rd Se Marietta |
| State: | GA US |
| Postal Code: | 300675326 |
| Phone Number: | 7709558620 |
| Fax Number: | 7709550377 |
| NPI Enumeration Date: | 06/10/2011 |
| NPI Last Update Date: | 06/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |