WELLSTAR FAMILY MEDICINE (GOVERNORS)
NPI 1689077562
Family Medicine in Acworth, GA
About Wellstar Family Medicine (governors) NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
WELLSTAR FAMILY MEDICINE (GOVERNORS) (NPI 1689077562) is a healthcare organization registered as a family medicine in Acworth, Georgia and active in the NPI registry since October 2014. The organization holds a CLIA Waiver certificate valid through September 15, 2028 and lists Nicole Ashe, Executive Director Of Finance, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Wellstar Family Medicine (governors) is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3,854Medicare enrollment records show 3,854 clinicians reassign Medicare billing to Wellstar Family Medicine (governors), which bills Medicare for the services they deliver. Of these, 5 practice at this address and 755 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 79
Nearest to this location (20)
See all 3,854Acworth, GA 30101
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 11D2311031
Wellstar Family Medicine Ivey Walk · Acworth, GAFrequently 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 1689077562. It was assigned to this organization in the NPPES registry on October 6, 2014. The provider is doing business as Wellstar Family Medicine (governors).
Where is Wellstar Medical Group, LLC located?
Wellstar Medical Group, LLC is located at 4900 Ivey Rd NW Suite 1301, Acworth, GA 30101. The listed phone number is (770) 975-9077.
What is Wellstar Medical Group, LLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Wellstar Medical Group, LLC enrolled in Medicare?
Yes. Wellstar Medical Group, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Wellstar Medical Group, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3,854 clinicians in 79 Medicare specialties reassign their Medicare billing to Wellstar Medical Group, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (773), Family Practice (246) and Internal Medicine (225). Of these, 5 practice at this address and 755 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Wellstar Medical Group, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D2311031) is associated with this NPI, valid through September 15, 2028. 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 May 28, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.
# Wellstar Family Medicine (governors) · NPI 1689077562
Family Medicine organization in Acworth, Georgia. Organization record, active in the CMS NPPES registry since October 6, 2014.
## Identity
- **NPI:** 1689077562 (Entity type: Organization)
- **Enumerated:** October 6, 2014
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Wellstar Medical Group, Llc
- **Organization subpart:** Yes (part of Wellstar Medical Group, Llc)
- **Authorized official:** Nicole Ashe, EXECUTIVE DIRECTOR OF FINANCE
## Practice location
- **Address:** 4900 IVEY RD NW, SUITE 1301, Acworth, GA 30101-4142
- **Phone:** (770) 975-9077 · **Fax:** (770) 790-4964
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3,854 clinicians in 79 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (773), Family Practice (246), Internal Medicine (225); 5 practice at this address and 755 within 10 miles; [full list](https://npiprofile.com/npi/1689077562/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 28, 2015
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1689077562) · Data from the CMS NPPES public registry.