Provider Demographics
NPI:1710135819
Name:WELLS, MARY ALICIA (DVM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALICIA
Last Name:WELLS
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 LEBANON ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1316
Mailing Address - Country:US
Mailing Address - Phone:615-872-5282
Mailing Address - Fax:615-872-9540
Practice Address - Street 1:4642 LEBANON ROAD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1316
Practice Address - Country:US
Practice Address - Phone:615-872-5282
Practice Address - Fax:615-872-9540
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDV0000004848174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian