| Wellstar Medical Group, Llc | |
|
1800 Parkway Pl Se Marietta GA 30067-8200 | |
| (470) 267-2433 | |
| Not Available |
| Full Name | Wellstar Medical Group, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1800 Parkway Pl Se, Marietta, Georgia |
| Authorized Official Name and Position | Maxwell Kagan (VP/CFO) |
| Authorized Official Contact | 4706440065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellstar Medical Group, Llc Po Box 742322 Atlanta GA 30374-2322 Ph: () - | Wellstar Medical Group, Llc 1800 Parkway Pl Se Marietta GA 30067-8200 Ph: (470) 267-2433 |
| NPI Number | 1275992240 |
|---|---|
| Provider Enumeration Date | 02/18/2016 |
| Last Update Date | 06/30/2023 |
| Medicare PECOS PAC ID | 6709065402 |
|---|---|
| Medicare Enrollment ID | O20230821000129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275992240 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Georgia) | Primary |
| Provider Name | George Sich |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1093804817 PECOS PAC ID: 5597745554 Enrollment ID: I20040721001214 |
| Provider Name | David J Terris |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1689683765 PECOS PAC ID: 5193710564 Enrollment ID: I20070306000453 |
| Provider Name | Michelle Maxwell Lyon |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164476479 PECOS PAC ID: 8729175187 Enrollment ID: I20080919000167 |
| Provider Name | Charlton Judson Pickett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366429854 PECOS PAC ID: 1951466051 Enrollment ID: I20090224000144 |
| Provider Name | Lane D Ulrich |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1730191081 PECOS PAC ID: 1850456344 Enrollment ID: I20111031000018 |
| Provider Name | Darlene Orcutt Batastini |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538435086 PECOS PAC ID: 9638334667 Enrollment ID: I20120626000101 |
| Provider Name | William Vaughn Mccall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902881485 PECOS PAC ID: 6901931807 Enrollment ID: I20140224001744 |
| Provider Name | Peter B Rosenquist |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033193099 PECOS PAC ID: 6204826001 Enrollment ID: I20140313002065 |
| Provider Name | Imran Yaseen Gani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427336742 PECOS PAC ID: 8426355595 Enrollment ID: I20191008003595 |
| Provider Name | Kathryn Potter |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1154740793 PECOS PAC ID: 9931327525 Enrollment ID: I20200210001558 |
| Provider Name | Sean Javaheri |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1982677605 PECOS PAC ID: 9830313410 Enrollment ID: I20200415000286 |
| Provider Name | Kendall Liner Buchanan |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1811359334 PECOS PAC ID: 5395080501 Enrollment ID: I20200629003549 |
| Provider Name | Cory A Bryan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1821437757 PECOS PAC ID: 0345483020 Enrollment ID: I20200727000339 |
| Provider Name | Matthew Belcher |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1134568520 PECOS PAC ID: 2264666809 Enrollment ID: I20201228000953 |
| Provider Name | Martin Rutkowski |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1780950923 PECOS PAC ID: 4789976556 Enrollment ID: I20210623003588 |
| Provider Name | Dan-victor Giurgiutiu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649434317 PECOS PAC ID: 1850552076 Enrollment ID: I20210624000256 |
| Provider Name | Colin Mcleod |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750720124 PECOS PAC ID: 5890086557 Enrollment ID: I20210625000451 |
| Provider Name | Evan Hiner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821400441 PECOS PAC ID: 8527358548 Enrollment ID: I20210707001119 |
| Provider Name | Daniel Sohinki |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992094106 PECOS PAC ID: 9739484106 Enrollment ID: I20210707002927 |
| Provider Name | Pushpa Shivaram |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1306192604 PECOS PAC ID: 1658503693 Enrollment ID: I20210712002313 |
| Provider Name | Benjamin Barnes |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1760866545 PECOS PAC ID: 4486948015 Enrollment ID: I20210816003907 |
| Provider Name | Tyler Vines |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1730618729 PECOS PAC ID: 5395019541 Enrollment ID: I20210817000567 |
| Provider Name | John Plowden |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1003814856 PECOS PAC ID: 2466534318 Enrollment ID: I20211011002486 |
| Provider Name | Jennifer T Allen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1487975702 PECOS PAC ID: 3274771134 Enrollment ID: I20211011002816 |
| Provider Name | Soumia Brakta |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1164749008 PECOS PAC ID: 0446476659 Enrollment ID: I20211217001756 |
| Provider Name | Michael Groves |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1215180526 PECOS PAC ID: 1759569767 Enrollment ID: I20220705001906 |
| Provider Name | James Kenneth Byrd |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1720285166 PECOS PAC ID: 6608031737 Enrollment ID: I20220811000534 |
| Provider Name | Scott Rahimi |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1093939118 PECOS PAC ID: 3476628710 Enrollment ID: I20220909001643 |
| Provider Name | Michelle Kotti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306883269 PECOS PAC ID: 6901990761 Enrollment ID: I20220930002318 |
| Provider Name | Vatsalya Kosuru |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1922536846 PECOS PAC ID: 1052707072 Enrollment ID: I20230123000744 |
| Provider Name | Ashish Kataria |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1487975926 PECOS PAC ID: 0345476214 Enrollment ID: I20230223003061 |
| Provider Name | Melissa Lynn Lefebvre |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720206550 PECOS PAC ID: 7911175823 Enrollment ID: I20240214004456 |
| Provider Name | Leighton Rolston James |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1346202173 PECOS PAC ID: 8921088477 Enrollment ID: I20240423000632 |
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