Provider Demographics
NPI:1053332841
Name:WELLS, CHARLES CHESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHESLEY
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:978-536-6141
Practice Address - Street 1:435 2ND ST
Practice Address - Street 2:430
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8298
Practice Address - Country:US
Practice Address - Phone:478-745-5779
Practice Address - Fax:478-742-7796
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0198072084S0012X
GAD198072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000260246GMedicaid
GA000260246HMedicaid
GA000260246JMedicaid
GA000260246IMedicaid
915875OtherBLUE CROSS
GA000260246KMedicaid
GAD41358Medicare UPIN
GA000260246KMedicaid