Provider Demographics
NPI:1275834616
Name:WELLSTAR
Entity Type:Organization
Organization Name:WELLSTAR
Other - Org Name:ENT ASSOCIATES OF NORTH GEORGIA
Other - Org Type:Other Name
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RATLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:770-793-7414
Mailing Address - Street 1:320 KENNESTONE HOSPITAL BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1161
Mailing Address - Country:US
Mailing Address - Phone:770-793-7417
Mailing Address - Fax:
Practice Address - Street 1:320 KENNESTONE HOSPITAL BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1161
Practice Address - Country:US
Practice Address - Phone:770-793-7417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003861231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty