Provider Demographics
NPI:1184791220
Name:WELLS, NICHOLAS JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAMES
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 1:910 BLACKFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1405
Mailing Address - Country:US
Mailing Address - Phone:423-778-5255
Mailing Address - Fax:423-778-8209
Practice Address - Street 1:910 BLACKFORD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1405
Practice Address - Country:US
Practice Address - Phone:423-778-5255
Practice Address - Fax:423-778-8209
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA39020000X208000000X
TN584902080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics