Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 13702 | GA |
NPI | 1023067725 |
---|---|
Provider Name | Dr. James O. Wells |
First Address | Atlanta, GA 30345-2663 |
Second Address | Atlanta, GA 30345-2745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 10/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000081683F | (05) | GA |
200045048 | BLUE SHIELD (01) | GA |
CLIA | 11D0875661 (01) | GA |
D41362 | (02) | GA |