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WELLSTAR PEDIATRIC & ADOLESCENT CENTER
NPI 1073819124
Pediatrics in Austell, GA

Active since February 08, 2011CLIA 11D0884136 · Waiver
1810 MULKEY RD, SUITE 201, AUSTELL, GA 30106(770) 819-9262(770) 819-0597 Get Directions Write a Review

NPPES record last updated: November 18, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Wellstar Pediatric & Adolescent Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WELLSTAR PEDIATRIC & ADOLESCENT CENTER (NPI 1073819124) is a healthcare organization registered as a pediatrics in Austell, Georgia and active in the NPI registry since February 2011. The organization holds a CLIA Waiver certificate valid through February 12, 2027 and lists Nicole Ashe, Executive Director Of Finance, as its authorized official.

NPPES Registry Identity

NPI1073819124
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameWELLSTAR MEDICAL GROUP, LLC
Location Address1810 MULKEY RD, SUITE 201Austell, GA 30106-1151
Mailing Address1810 Mulkey Rd, Suite 201Austell, GA 30106-1151 · (770) 819-9262 · Fax (770) 819-0597
Phone(770) 819-9262
Fax(770) 819-0597
Organization SubpartYes
Authorized OfficialNicole AsheExecutive Director Of Finance · (470) 644-0095
Enumeration DateFebruary 8, 2011
Last NPPES UpdateNovember 18, 2013
✔ NPI 1073819124 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
1810 MULKEY RD, Austell, GA 30106
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Other Names 1

Doing Business AsWellstar Pediatric & Adolescent Center

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0884136

Wellstar Pediatric Adolescent Center - Austell · Austell, GA
Active · expires Feb 12, 2027
CLIA Number11D0884136
Laboratory TypePhysician Office
Certificate Effective DateFebruary 13, 2025
Certificate Expiration DateFebruary 12, 2027
Laboratory DirectorDr. Annisha P. Ellis
Laboratory Phone(770) 819-9262
Laboratory LocationWellstar Pediatric Adolescent Center - Austell2840 East West Connector, Suite 350, Austell, GA 30106
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WELLSTAR PEDIATRIC & FAMILY WELLNESS CENTER, LLC
Psychologist (Clinical)
1810 MULKEY RD, SUITE 201
AUSTELL, GA 30106
Cobb County (770) 634-2349
NISSI FAMILY MEDICINE LLC
Family Medicine
1810 MULKEY RD, SUITE 105
AUSTELL, GA 30106
Cobb County (678) 540-7597
ATLANTA KIDNEY AND HYPERTENSION ASSOCIATES
Internal Medicine (Nephrology)
1810 MULKEY RD, SUITE 103
AUSTELL, GA 30106
Cobb County (770) 732-8464
CASCADE RADIOLOGY CONSULTANTS, PC
Radiology (Diagnostic Radiology)
1810 MULKEY RD, STE 103
AUSTELL, GA 30106
Cobb County (770) 980-8970
AUTUMN ROSS CPNP
Pediatrics
1810 MULKEY RD
AUSTELL, GA 30106
Cobb County (770) 819-9262
WELLSTAR PEDIATRIC & ADOLESCENT CENTER, LLC
Pediatrics
1810 MULKEY RD, SUITE 201
AUSTELL, GA 30106
Cobb County (770) 819-9262
DR. TWANDA E LIGHTFOOT PHD
Psychologist
1810 MULKEY RD, SUITE 201
AUSTELL, GA 30106
Cobb County (770) 634-2349
JAMES A. SEXSON, M.D. LLC
Internal Medicine
1810 MULKEY RD, SUITE 200
AUSTELL, GA 30106
Cobb County (770) 944-0811

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wellstar Medical Group, LLC's NPI number?

The NPI number for Wellstar Medical Group, LLC is 1073819124. It was assigned to this organization in the NPPES registry on February 8, 2011. The provider is doing business as Wellstar Pediatric & Adolescent Center.

Where is Wellstar Medical Group, LLC located?

Wellstar Medical Group, LLC is located at 1810 Mulkey Rd Suite 201, Austell, GA 30106. The listed phone number is (770) 819-9262.

What is Wellstar Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Wellstar Medical Group, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0884136) is associated with this NPI, valid through February 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Wellstar Medical Group, LLC was last updated on November 18, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.