Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4069 | AK |
N | 111NI0900X | Internist | 4069 | AK |
N | 207RC0200X | Critical Care Medicine | 4069 | AK |
Y | 207RP1001X | Pulmonary Disease | 4069 | AK |
NPI | 1063471183 |
---|---|
Provider Name | Timothy Wells |
First Address | Charleston, SC 29401-5703 |
Second Address | Charleston, SC 29401-5703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2006 |
Last Update Date | 18/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F50169 | (02) |