Provider Demographics
NPI:1619973815
Name:WELLMAN, JAMES JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JORDAN
Last Name:WELLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:STE 380
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1713
Mailing Address - Country:US
Mailing Address - Phone:404-257-0080
Mailing Address - Fax:404-257-0592
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:STE 380
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1713
Practice Address - Country:US
Practice Address - Phone:404-257-0080
Practice Address - Fax:404-257-0592
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA014677207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00114804DMedicaid
GAB76498Medicare UPIN