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WELLSTAR SHALLOWFORD MEDICAL CENTER, LLC
NPI 1144276270
Internal Medicine in Marietta, GA

Active since May 26, 2006CLIA 11D0933113 · Waiver
3921 SHALLOWFORD RD, MARIETTA, GA 30062(770) 649-9100(770) 949-9092 Get Directions Write a Review

NPPES record last updated: July 14, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Wellstar Shallowford Medical Center, Llc NPPES

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

WELLSTAR SHALLOWFORD MEDICAL CENTER, LLC (NPI 1144276270) is a healthcare organization registered as an internal medicine in Marietta, Georgia and active in the NPI registry since May 2006. The organization holds a CLIA Waiver certificate valid through April 21, 2027 and lists Nicole Ashe, Executive Director Of Finance, as its authorized official.

NPPES Registry Identity

NPI1144276270
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameWELLSTAR SHALLOWFORD MEDICAL CENTER, LLC
Location Address3921 SHALLOWFORD RDMarietta, GA 30062-5013
Mailing Address3921 Shallowford RdMarietta, GA 30062-5013 · (770) 649-9100 · Fax (770) 949-9092
Phone(770) 649-9100
Fax(770) 949-9092
Organization SubpartYesParent: Wellstar Health System, Inc.
Authorized OfficialNicole AsheExecutive Director Of Finance · (770) 792-5261
Enumeration DateMay 26, 2006
Last NPPES UpdateJuly 14, 2008
✔ NPI 1144276270 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
3921 SHALLOWFORD RD, Marietta, GA 30062
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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 11D0933113

Wellstar Shallowford Medical Center · Marietta, GA
Active · expires Apr 21, 2027
CLIA Number11D0933113
Laboratory TypePhysician Office
Certificate Effective DateApril 22, 2025
Certificate Expiration DateApril 21, 2027
Laboratory DirectorReaz M. Siddiqui
Laboratory Phone(770) 649-9100
Laboratory LocationWellstar Shallowford Medical Center3921 Shallowford Road, Marietta, GA 30062
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

WELLSTAR MEDICAL GROUP, LLC
Internal Medicine
3921 SHALLOWFORD RD
MARIETTA, GA 30062
Cobb County (770) 649-9100
DR. REAZ SIDDIQUI M.D.
Internal Medicine
3921 SHALLOWFORD RD
MARIETTA, GA 30062
Cobb County (770) 649-0049
DR. FOLAKE OLUMAYOWA TAYLOR M.D.
Internal Medicine
3921 SHALLOWFORD RD
MARIETTA, GA 30062
Cobb County (770) 649-0049

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 Shallowford Medical Center, LLC's NPI number?

The NPI number for Wellstar Shallowford Medical Center, LLC is 1144276270. It was assigned to this organization in the NPPES registry on May 26, 2006.

Where is Wellstar Shallowford Medical Center, LLC located?

Wellstar Shallowford Medical Center, LLC is located at 3921 Shallowford Rd, Marietta, GA 30062. The listed phone number is (770) 649-9100.

What is Wellstar Shallowford Medical Center, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Wellstar Shallowford Medical Center, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0933113) is associated with this NPI, valid through April 21, 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 Shallowford Medical Center, LLC was last updated on July 14, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.