Provider Demographics
NPI:1194025486
Name:WELLS, COURTNEY ANNE (LMT)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:ANNE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-4813
Mailing Address - Country:US
Mailing Address - Phone:478-289-7778
Mailing Address - Fax:478-289-7776
Practice Address - Street 1:105 S CIRCLE DR
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-4813
Practice Address - Country:US
Practice Address - Phone:478-289-7778
Practice Address - Fax:478-289-7776
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT006029225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist