Provider Demographics
NPI:1447801576
Name:WELLS, JOEY LEMAR JR
Entity Type:Individual
Prefix:MR
First Name:JOEY
Middle Name:LEMAR
Last Name:WELLS
Suffix:JR
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 1:4817 YORK ST APT 218
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1134
Mailing Address - Country:US
Mailing Address - Phone:504-251-2289
Mailing Address - Fax:
Practice Address - Street 1:4817 YORK ST APT 218
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1134
Practice Address - Country:US
Practice Address - Phone:504-251-2289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONEXISTENT172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE