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WELLSTAR FAMILY MEDICINE (GOVERNORS)
NPI 1689077562
Family Medicine in Acworth, GA

Active since October 06, 2014CLIA 11D2311031 · Waiver
4900 IVEY RD NW, SUITE 1301, ACWORTH, GA 30101(770) 975-9077(770) 790-4964 Get Directions Write a Review

NPPES record last updated: May 28, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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, 2026 and lists Nicole Ashe, Executive Director Of Finance, as its authorized official.

NPPES Registry Identity

NPI1689077562
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameWELLSTAR MEDICAL GROUP, LLC
Location Address4900 IVEY RD NW, SUITE 1301Acworth, GA 30101-4142
Mailing Address4900 Ivey Rd Nw, Suite 1301Acworth, GA 30101-4142 · (770) 975-9077 · Fax (770) 790-4964
Phone(770) 975-9077
Fax(770) 790-4964
Organization SubpartYes
Authorized OfficialNicole AsheExecutive Director Of Finance · (470) 644-0095
Enumeration DateOctober 6, 2014
Last NPPES UpdateMay 28, 2015
✔ NPI 1689077562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4900 IVEY RD NW, Acworth, GA 30101
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Other Names 1

Doing Business AsWellstar Family Medicine (governors)

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 11D2311031

Wellstar Family Medicine Ivey Walk · Acworth, GA
Active · expires Sep 15, 2026
CLIA Number11D2311031
Laboratory TypePhysician Office
Certificate Effective DateSeptember 16, 2024
Certificate Expiration DateSeptember 15, 2026
Laboratory DirectorFracheska Alcide
Laboratory Phone(770) 975-9077
Laboratory LocationWellstar Family Medicine Ivey Walk4900 Ivey Road, NW, Suite 1301, Acworth, GA 30101
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 14

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

BRIANNA COLEMAN OTR/L
Occupational Therapist
4900 IVEY RD NW
ACWORTH, GA 30101
Cobb County (770) 917-5737
MOLLIE ARCHER DPT
Physical Therapist
4900 IVEY RD NW, BUILDING 1000 SUITE 1001
ACWORTH, GA 30101
Cobb County (770) 917-0924
JOHN N MURIMI MD
Family Medicine
4900 IVEY RD NW, SUITE 1301
ACWORTH, GA 30101
Cobb County (770) 974-4655
GOVERNORS FAMIILY MEDICAL GROUP, LLC
Family Medicine
4900 IVEY RD NW, SUITE 1826
ACWORTH, GA 30101
Cobb County (770) 975-9077
AMIRA SHAFEY
Family Medicine
4900 IVEY RD NW
ACWORTH, GA 30101
Cobb County (770) 975-9077
LEE BRIAN BRANDT JR. PA
Physician Assistant (Medical)
4900 IVEY RD NW, SUITE 1826
ACWORTH, GA 30101
Cobb County (770) 975-9077
MRS. WILMA BLAKE FAULKNER L.AC., DIPL O.M.
Acupuncturist
4900 IVEY RD NW, SUITE 820
ACWORTH, GA 30101
Cobb County (770) 975-9233
TYE MARR PT
Physical Therapist
4900 IVEY RD NW, SUITE 1001
ACWORTH, GA 30101
Cobb County (770) 917-0924

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 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.

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, 2026. 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.