Provider Demographics
NPI:1861582827
Name:WELLS, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8023
Mailing Address - Country:US
Mailing Address - Phone:478-751-0183
Mailing Address - Fax:478-746-1471
Practice Address - Street 1:310 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8023
Practice Address - Country:US
Practice Address - Phone:478-751-0183
Practice Address - Fax:478-746-1471
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA010689208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000071376BMedicaid
257524576AMedicare ID - Type Unspecified
D42183Medicare UPIN