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WELLSTAR MEDICAL SPECIALISTS
NPI 1629374681
Internal Medicine - Endocrinology, Diabetes & Metabolism in Marietta, GA

Active since February 08, 2011CLIA 11D0705443 · Waiver
625 CHURCH ST NE, MARIETTA, GA 30060(770) 422-2004(770) 422-8465 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 Medical Specialists NPPES

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

WELLSTAR MEDICAL SPECIALISTS (NPI 1629374681) is a healthcare organization registered as an endocrinology, diabetes & metabolism in Marietta, Georgia and active in the NPI registry since February 2011. The organization holds a CLIA Waiver certificate valid through April 6, 2027 and lists Nicole Ashe, Executive Director Of Finance, as its authorized official.

NPPES Registry Identity

NPI1629374681
Entity TypeOrganization
Primary Taxonomy207RE0101X
Legal Business NameWELLSTAR MEDICAL GROUP, LLC
Location Address625 CHURCH ST NEMarietta, GA 30060-1101
Mailing Address625 Church St NeMarietta, GA 30060-1101 · (770) 422-2004 · Fax (770) 422-8465
Phone(770) 422-2004
Fax(770) 422-8465
Organization SubpartYes
Authorized OfficialNicole AsheExecutive Director Of Finance · (470) 644-0095
Enumeration DateFebruary 8, 2011
Last NPPES UpdateNovember 18, 2013
✔ NPI 1629374681 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · Endocrinology, Diabetes & MetabolismAllopathic & Osteopathic Physicians
Taxonomy Code207RE0101X
Definition
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.
Also ListedInternal MedicineTaxonomy 207R00000X
625 CHURCH ST NE, Marietta, GA 30060
Open in Google Maps ↗

Other Names 1

Doing Business AsWellstar Medical Specialists

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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 11D0705443

Wellstar Medical Specialists · Marietta, GA
Active · expires Apr 6, 2027
CLIA Number11D0705443
Laboratory TypePhysician Office
Certificate Effective DateApril 7, 2025
Certificate Expiration DateApril 6, 2027
Laboratory DirectorSeymour J. Rosenbloom
Laboratory Phone(770) 422-2004
Laboratory LocationWellstar Medical Specialists625 Church Street, NE, Marietta, GA 30060
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 5

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

MARIETTA OB GYN AFFILIATES 2 LLC
Obstetrics & Gynecology
625 CHURCH ST NE
MARIETTA, GA 30060
Cobb County (404) 943-0205
DR. SADEKA SHAHANI MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
625 CHURCH ST NE
MARIETTA, GA 30060
Cobb County (770) 422-2004
DR. JEROME B BLUMENTHAL MD
Internal Medicine
625 CHURCH ST NE
MARIETTA, GA 30060
Cobb County (770) 422-2004
BENYAMIN FARAHVASH M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
625 CHURCH ST NE
MARIETTA, GA 30060
Cobb County (770) 422-2004
DR. SRINIVAS BONTHA M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
625 CHURCH ST NE
MARIETTA, GA 30060
Cobb County (770) 422-2004

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 1629374681. It was assigned to this organization in the NPPES registry on February 8, 2011. The provider is doing business as Wellstar Medical Specialists.

Where is Wellstar Medical Group, LLC located?

Wellstar Medical Group, LLC is located at 625 Church St NE, Marietta, GA 30060. The listed phone number is (770) 422-2004.

What is Wellstar Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Endocrinology, Diabetes & Metabolism, with taxonomy code 207RE0101X.

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

Yes. A Certificate of Waiver (number 11D0705443) is associated with this NPI, valid through April 6, 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.