Basic Information
| Provider Information | |||||||||
| NPI: | 1972535318 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLSTAR SPALDING REGIONAL HOSPITAL, INC | ||||||||
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| OtherOrganizationName: | WELLSTAR SPALDING REGIONAL HOSPITAL | ||||||||
| 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: | 601 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | GRIFFIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302244213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702282721 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUDZINSKI | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EVP & CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4706440012 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 11-0031 | GA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 07606293 | 05 | MS | MEDICAID | 100033 | 01 | BCBS OF GEORGIA | OTHER | 1707929 | 05 | LA | MEDICAID | 00000866A | 05 | GA | MEDICAID | 048097480 | 01 | AETNA US HEALTHCARE | OTHER | 7975 | 01 | COVENTRY HEALTH CARE GEOR | OTHER |