Provider Demographics
NPI:1053450064
Name:WELLS, DEMETRIS R JR (BS)
Entity Type:Individual
Prefix:
First Name:DEMETRIS
Middle Name:R
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 S. MAPLE ST.
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:205-356-6039
Mailing Address - Fax:
Practice Address - Street 1:907 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1429
Practice Address - Country:US
Practice Address - Phone:615-666-8070
Practice Address - Fax:615-666-6933
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker