Provider Demographics
NPI:1407921653
Name:WELLSTAR HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:WELLSTAR HEALTH SYSTEM, INC.
Other - Org Name:WINDY HILL APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:WOOTEN
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-644-1090
Mailing Address - Street 1:2520 WINDY HILL ROAD
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8664
Mailing Address - Country:US
Mailing Address - Phone:770-644-1005
Mailing Address - Fax:770-644-1008
Practice Address - Street 1:2520 WINDY HILL ROAD
Practice Address - Street 2:SUITE 203A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8664
Practice Address - Country:US
Practice Address - Phone:770-644-1005
Practice Address - Fax:770-644-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE005383183500000X
GARPH014647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1136628OtherNABP