Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kendrick Ruelo De Castro, PA-C

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1235967050

Kendrick Ruelo De Castro, PA-C is a Physician Assistant in Marietta, Georgia. Qualified in 2024, 2 years ago. Practices with Wellstar Medical Group LLC, a 3,072-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
2
Licensed in
GA
In the registry since
2024
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

400 Tower Rd NE Ste 200
Marietta, GA 30060-9412
Phone: (770) 422-1372
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1664 Mulkey Rd, Austell, GA 30106-1114 — (770) 422-1372

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 12626 (GA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1235967050
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedJuly 23, 2024
Last updated in NPPESOctober 21, 2024
Certification dateOctober 21, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Wellstar Medical Group Llc — 3072 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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