Provider Demographics
NPI:1134107287
Name:MARTIN, WELLS III (MD)
Entity Type:Individual
Prefix:DR
First Name:WELLS
Middle Name:
Last Name:MARTIN
Suffix:III
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 1:1304 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7318
Mailing Address - Country:US
Mailing Address - Phone:336-885-9211
Mailing Address - Fax:336-885-9210
Practice Address - Street 1:109 MUIRS CHAPEL RD
Practice Address - Street 2:STE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-6161
Practice Address - Country:US
Practice Address - Phone:336-542-2900
Practice Address - Fax:336-542-2929
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00197098OtherRRMC - INDIVIDUAL
NC300033904OtherRAILROAD MEDICARE
NC54504OtherBCBSNC
NC8954504Medicaid
NCP00197098OtherRAILROAD MEDICARE
NC213454AMedicare ID - Type Unspecified
NC213454JMedicare PIN
NCC82529Medicare UPIN