Provider Demographics
NPI:1205463163
Name:WELLBE SENIOR MEDICAL GROUP OF GEORGIA, P. C.
Entity type:Organization
Organization Name:WELLBE SENIOR MEDICAL GROUP OF GEORGIA, P. C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:IYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-776-2415
Mailing Address - Street 1:20 W KINZIE ST STE 17
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-6393
Mailing Address - Country:US
Mailing Address - Phone:312-776-2421
Mailing Address - Fax:
Practice Address - Street 1:5 CONCOURSE PKWY STE 3100
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-7117
Practice Address - Country:US
Practice Address - Phone:855-492-7642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty