Provider Demographics
NPI:1548200447
Name:WELLS, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9 RICHLAND MEDICAL PARK
Mailing Address - Street 2:STE 510
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6860
Mailing Address - Country:US
Mailing Address - Phone:803-256-2483
Mailing Address - Fax:803-799-4624
Practice Address - Street 1:9 RICHLAND MEDICAL PARK
Practice Address - Street 2:STE 510
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6860
Practice Address - Country:US
Practice Address - Phone:803-256-2483
Practice Address - Fax:803-799-4624
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC15278207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL5893Medicaid
SCD90640Medicare UPIN
SCTL5893Medicaid