Provider Demographics
NPI:1598795585
Name:WELLSTAR ATLANTA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:WELLSTAR ATLANTA MEDICAL CENTER, INC
Other - Org Name:WELLSTAR ATLANTA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-644-0012
Mailing Address - Street 1:1800 PARKWAY PL SE STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8237
Mailing Address - Country:US
Mailing Address - Phone:470-956-4981
Mailing Address - Fax:770-792-5272
Practice Address - Street 1:303 PARKWAY DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1212
Practice Address - Country:US
Practice Address - Phone:404-265-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QA1903X
GA060-551282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000789AMedicaid
IL582329008001OtherBCBS ILLINOIS
NC1100115Medicaid
AZ58909OtherBCBS OF ARIZONA
ALATL0115NMedicaid
000445OtherHUMANA
GA13313OtherCOVENTRY HEALTH CARE GEOR
MS03521208Medicaid
GA110115B000000OtherSECTION 1011
LA1707945Medicaid
SC1990AMedicaid
573351850OtherAETNA US HEALTHCARE (NATI
FL918757200OtherMEDICAID OF FLORIDA
GA000001713AMedicaid
GA003419OtherBCBS OF GEORGIA
NC1100115Medicaid