Provider Demographics
NPI:1013330364
Name:WELLSTAR HEALTH SYSTEMS
Entity Type:Organization
Organization Name:WELLSTAR HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAXIT
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-956-8364
Mailing Address - Street 1:1680 HOSPITAL SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8110
Mailing Address - Country:US
Mailing Address - Phone:470-956-8364
Mailing Address - Fax:
Practice Address - Street 1:1680 HOSPITAL SOUTH DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8110
Practice Address - Country:US
Practice Address - Phone:470-956-8364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64951261QM2500X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No282N00000XHospitalsGeneral Acute Care Hospital