Basic Information
| Provider Information | |||||||||
| NPI: | 1528093960 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLSTAR ATLANTA MEDICAL CENTER, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WELLSTAR ATLANTA MEDICAL CENTER INPATIENT PSYCH UNIT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 PARKWAY PL SE STE 500 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300678237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4709564981 | ||||||||
| FaxNumber: | 7709992489 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 PARKWAY DR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303121212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042654000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUDZINSKI | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP | ||||||||
| AuthorizedOfficialTelephone: | 4706440012 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ATLANTA MEDICAL CENTER, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 060-551 | GA | Y | Hospital Units | Psychiatric Unit |
No ID Information.