Provider Demographics
NPI:1205874062
Name:WELLMAN, AMBER LUSHEA (DC)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:LUSHEA
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CHAPEL CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-0529
Mailing Address - Country:US
Mailing Address - Phone:912-554-2002
Mailing Address - Fax:912-554-2290
Practice Address - Street 1:124 CHAPEL CROSSING RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0529
Practice Address - Country:US
Practice Address - Phone:912-554-2002
Practice Address - Fax:912-554-2290
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJPMMedicare PIN