Provider Demographics
NPI:1255895553
Name:WELLS, DONNA KENYATTIA
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:KENYATTIA
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:PEARSON
Mailing Address - State:GA
Mailing Address - Zip Code:31642-0125
Mailing Address - Country:US
Mailing Address - Phone:912-592-7945
Mailing Address - Fax:
Practice Address - Street 1:214 BROUGHTON ST
Practice Address - Street 2:
Practice Address - City:PEARSON
Practice Address - State:GA
Practice Address - Zip Code:31642-7044
Practice Address - Country:US
Practice Address - Phone:912-592-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor