Provider Demographics
NPI:1134964554
Name:WELLS, GEORGE GARY JR (FPC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:GARY
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:FPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-1501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:YAKUTAT
Practice Address - State:AK
Practice Address - Zip Code:99689
Practice Address - Country:US
Practice Address - Phone:907-784-3206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK21506414146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic