Provider Demographics
NPI:1912205477
Name:JOHN A WELLS MD PA
Entity Type:Organization
Organization Name:JOHN A WELLS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-405-7977
Mailing Address - Street 1:440 CHARTER BLVD
Mailing Address - Street 2:SUITE 3302
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4857
Mailing Address - Country:US
Mailing Address - Phone:478-405-7977
Mailing Address - Fax:
Practice Address - Street 1:440 CHARTER BLVD
Practice Address - Street 2:SUITE 3302
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4857
Practice Address - Country:US
Practice Address - Phone:478-405-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000071376BMedicaid
GA000071376BMedicaid