Provider Demographics
NPI:1407443864
Name:WELLS, WEST
Entity Type:Individual
Prefix:
First Name:WEST
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18741 US HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31001-1982
Mailing Address - Country:US
Mailing Address - Phone:478-867-2943
Mailing Address - Fax:
Practice Address - Street 1:18741 US HIGHWAY 129
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31001-1982
Practice Address - Country:US
Practice Address - Phone:478-867-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0209211835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric