Provider Demographics
NPI:1023067725
Name:WELLS, JAMES O (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:O
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2249 GREENCREST DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2663
Mailing Address - Country:US
Mailing Address - Phone:770-934-2585
Mailing Address - Fax:770-493-6526
Practice Address - Street 1:2300 HENDERSON MILL RD NE
Practice Address - Street 2:SUITE 421
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2745
Practice Address - Country:US
Practice Address - Phone:770-934-2585
Practice Address - Fax:770-493-6526
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13702207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000081683FMedicaid
GA200045048OtherBLUE SHIELD
GACLIAOther11D0875661
GACLIAOther11D0875661