Provider Demographics
NPI:1063680049
Name:WELLSTAR PALLIATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:WELLSTAR PALLIATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-732-6770
Mailing Address - Street 1:4040 HOSPITAL WEST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8117
Mailing Address - Country:US
Mailing Address - Phone:770-732-6770
Mailing Address - Fax:770-732-6710
Practice Address - Street 1:4040 HOSPITAL WEST DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8117
Practice Address - Country:US
Practice Address - Phone:770-732-6770
Practice Address - Fax:770-732-6710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSTAR HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-13
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty