Provider Demographics
NPI:1528386349
Name:WELLSTAR RHEUMATOLOGY, LLC
Entity Type:Organization
Organization Name:WELLSTAR RHEUMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-792-5261
Mailing Address - Street 1:4480 N COOPER LAKE RD SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4622
Mailing Address - Country:US
Mailing Address - Phone:770-792-5275
Mailing Address - Fax:770-941-6466
Practice Address - Street 1:4480 N COOPER LAKE RD SE
Practice Address - Street 2:SUITE 201
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4622
Practice Address - Country:US
Practice Address - Phone:770-792-5275
Practice Address - Fax:770-941-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty