Provider Demographics
NPI:1003088287
Name:WELLS, PATRICIA G (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:G
Last Name:WELLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 MEDICAL CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:COPPERHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37317-5006
Mailing Address - Country:US
Mailing Address - Phone:423-496-4390
Mailing Address - Fax:423-496-4392
Practice Address - Street 1:1912 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6524
Practice Address - Country:US
Practice Address - Phone:229-985-5684
Practice Address - Fax:229-985-3641
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA549828101AMedicaid