Provider Demographics
NPI:1780685743
Name:WELLS, WAYNE O (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:O
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1430 W BADDOUR PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2656
Mailing Address - Country:US
Mailing Address - Phone:615-443-0730
Mailing Address - Fax:615-443-0722
Practice Address - Street 1:1430 W BADDOUR PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2656
Practice Address - Country:US
Practice Address - Phone:615-443-0730
Practice Address - Fax:615-443-0722
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000019895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3045377Medicaid
TN3045377Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TNC10128Medicare UPIN
TN3045377Medicaid