Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 045664 | GA |
NPI | 1194799965 |
---|---|
Provider Name | William A Wells |
First Address | Evans, GA 30809-3000 |
Second Address | Evans, GA 30809-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 06/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000795286F | (05) | GA |
040015831 | MEDICARE RAILROAD (01) | GA |
157315300 | EMPLYMENT STANDARD WORKER (01) | |
245524 | BLUE CROSS (01) | GA |
4492627005 | CIGNA (01) | |
5110650 | AETNA (01) | |
G01624 | (02) |