| Organization Name: | WELLSTAR MEDICAL GROUP, LLC |
| NPI Number: | 1083910046 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE ASHE (EXECUTIVE DIRECTOR OF FINANCE) |
| Mailing Address: | 6095 Professional Pkwy Suite A-210 Douglasville |
| State: | GA US |
| Postal Code: | 301345607 |
| Phone Number: | 7709494188 |
| Fax Number: | 7709491614 |
| NPI Enumeration Date: | 02/08/2011 |
| NPI Last Update Date: | 11/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |