Provider Demographics
NPI:1467991992
Name:WELLSPINE LLC
Entity Type:Organization
Organization Name:WELLSPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1901-649-4228
Mailing Address - Street 1:3000 WINDY HILL RD #674591
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 WINDY HILL RD #674591
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30006
Practice Address - Country:US
Practice Address - Phone:404-913-6462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty