1750312997 NPI number — WELLSTAR NORTH FULTON HOSPITAL, INC

Table of content: (NPI 1750312997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750312997 NPI number — WELLSTAR NORTH FULTON HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLSTAR NORTH FULTON HOSPITAL, 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:
Provider Other Organization Name Type Code:
6
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:
1750312997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2024
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:
770-999-2489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 HOSPITAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-751-2500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2006

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 & CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
470-644-0012

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  060-357 , 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: 00275976A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1708127 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11486B , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2535591 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 61882 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 902706800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: NOR0198N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100012 . This is a "BCBS OF GEORGIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19913260 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199132600 . This is a "US DEPT OF LABOR WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100019 . This is a "BCBS OF GEORGIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11053A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 587768460 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110198B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1100198 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46922 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9852 . This is a "COVENTRY HEALTH CARE LOUI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 109091600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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