Provider Demographics
NPI:1740782531
Name:WELLSTAR ATLANTA MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:WELLSTAR ATLANTA MEDICAL CENTER, INC
Other - Org Name:WELLSTAR ATLANTA MEDICAL CENTER PT. B SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
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:
Practice Address - Street 1:1000 CORPORATE CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4129
Practice Address - Country:US
Practice Address - Phone:770-968-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSTAR ATLANTA MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-07
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000789AMedicaid