| Organization Name: | WELLSTAR MEDICAL GROUP, LLC |
| NPI Number: | 1023301033 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE) |
| Mailing Address: | 4480 N Cooper Lake Rd Se Suite 201 Smyrna |
| State: | GA US |
| Postal Code: | 300824622 |
| Phone Number: | 7703332035 |
| Fax Number: | 7703332059 |
| NPI Enumeration Date: | 05/24/2011 |
| NPI Last Update Date: | 11/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RR0500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Rheumatology |
| Taxonomy Definition: | An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |