Provider Demographics
NPI:1629399555
Name:WELLSTAR BI-COUNTY ENT, LLC
Entity Type:Organization
Organization Name:WELLSTAR BI-COUNTY ENT, 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 1:6002 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5600
Mailing Address - Country:US
Mailing Address - Phone:770-949-4200
Mailing Address - Fax:770-949-5553
Practice Address - Street 1:6002 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5600
Practice Address - Country:US
Practice Address - Phone:770-949-4200
Practice Address - Fax:770-949-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty