1598795585 NPI number — WELLSTAR ATLANTA MEDICAL CENTER, INC

Table of content: (NPI 1598795585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598795585 NPI number — WELLSTAR ATLANTA MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSTAR ATLANTA MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WELLSTAR ATLANTA MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598795585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 PARKWAY PL SE STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067-8237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-956-4981
Provider Business Mailing Address Fax Number:
770-792-5272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 PARKWAY DR NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30312-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-265-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUDZINSKI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EVP
Authorized Official Telephone Number:
470-644-0012

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 060-551 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000789A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 582329008001 . This is a "BCBS ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1100115 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58909 . This is a "BCBS OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: ATL0115N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000445 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13313 . This is a "COVENTRY HEALTH CARE GEOR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 03521208 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110115B000000 . This is a "SECTION 1011" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1707945 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1990A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 573351850 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 918757200 . This is a "MEDICAID OF FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 000001713A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003419 . This is a "BCBS OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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