Provider Demographics
NPI:1265647812
Name:WELLSTAR PAULDING MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:WELLSTAR PAULDING MEDICAL CENTER, INC.
Other - Org Name:WELLSTAR PAULDING HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:SNEHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:470-644-0322
Mailing Address - Street 1:2518 JIMMY LEE SMITH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141
Mailing Address - Country:US
Mailing Address - Phone:470-644-7010
Mailing Address - Fax:470-644-7394
Practice Address - Street 1:2518 JIMMY LEE SMITH PARKWAY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:470-644-7020
Practice Address - Fax:470-644-7394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHH007939282N00000X
GAPHRE0026493336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00001438BMedicaid
GAPHRE002649OtherSTATE LICENSE #