Provider Demographics
NPI:1275879595
Name:WELLSTAR HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:WELLSTAR HEALTHCARE SYSTEM
Other - Org Name:WELLSTAR HEALTH VENTURES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:770-792-5284
Mailing Address - Street 1:805 SANDY PLAINS RD
Mailing Address - Street 2:ATTENTION: REVENUE MANAGEMENT
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6340
Mailing Address - Country:US
Mailing Address - Phone:770-792-5284
Mailing Address - Fax:770-792-1513
Practice Address - Street 1:818 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8969
Practice Address - Country:US
Practice Address - Phone:770-792-5284
Practice Address - Fax:770-792-1513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007517261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health