Provider Demographics
NPI:1215001888
Name:WELLSTAR URGENT CARE AT COOPER LAKE, LLC
Entity Type:Organization
Organization Name:WELLSTAR URGENT CARE AT COOPER LAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-792-5261
Mailing Address - Street 1:4480 N COOPER LAKE ROAD SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMRYNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082
Mailing Address - Country:US
Mailing Address - Phone:770-331-1300
Mailing Address - Fax:770-432-8312
Practice Address - Street 1:4480 N COOPER LAKE ROAD SE
Practice Address - Street 2:SUITE 100
Practice Address - City:SMRYNA
Practice Address - State:GA
Practice Address - Zip Code:30082
Practice Address - Country:US
Practice Address - Phone:770-331-1300
Practice Address - Fax:770-432-8312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSTAR HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty