Provider Demographics
NPI:1821076001
Name:WELLSTAR HEALTH SYSTEM, INC
Entity Type:Organization
Organization Name:WELLSTAR HEALTH SYSTEM, INC
Other - Org Name:WELLSTAR HOMECARE SERVICES - PRIVATE HOMECARE
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:770-999-2489
Practice Address - Street 1:805 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-6340
Practice Address - Country:US
Practice Address - Phone:770-792-1616
Practice Address - Fax:770-792-1687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLSTAR HOMECARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-06
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003-R-0043251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00862694AMedicaid
GA00904593BMedicaid
GA00862694BMedicaid