Provider Demographics
NPI:1205838927
Name:WELLS, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:115 MEDICAL PARK DRIVE
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420
Mailing Address - Country:US
Mailing Address - Phone:334-222-5781
Mailing Address - Fax:334-222-5794
Practice Address - Street 1:115 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420
Practice Address - Country:US
Practice Address - Phone:334-222-5781
Practice Address - Fax:334-222-5794
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51018464OtherBLUE CROSS BLUE SHIELD
AL102048Medicaid
AL51018464OtherBLUE CROSS BLUE SHIELD
AL000018464Medicare ID - Type Unspecified