| Wellspring Ge Inc | |
|
3886 Princeton Lakes Way Sw Ste 120 Atlanta GA 30331-5511 | |
| (302) 401-9193 | |
| Not Available |
| Full Name | Wellspring Ge Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 3886 Princeton Lakes Way Sw Ste 120, Atlanta, Georgia |
| Authorized Official Name and Position | John Green (OWNER) |
| Authorized Official Contact | 3024019193 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellspring Ge Inc 3886 Princeton Lakes Way Sw Ste 120 Atlanta GA 30331-5511 Ph: (302) 401-9193 | Wellspring Ge Inc 3886 Princeton Lakes Way Sw Ste 120 Atlanta GA 30331-5511 Ph: (302) 401-9193 |
| NPI Number | 1417731563 |
|---|---|
| Provider Enumeration Date | 08/21/2023 |
| Last Update Date | 08/21/2023 |
| Certification Date | 08/21/2023 |
| Medicare PECOS PAC ID | 7911356126 |
|---|---|
| Medicare Enrollment ID | O20231213003300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417731563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Nina N Jefferson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1881912137 PECOS PAC ID: 3971795410 Enrollment ID: I20101005001185 |
| Provider Name | John Green |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467491266 PECOS PAC ID: 5698059384 Enrollment ID: I20231213003595 |
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