Provider Demographics
NPI:1295287266
Name:WELLS, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
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 1:516 YOUNGS FARM RD
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-5894
Mailing Address - Country:US
Mailing Address - Phone:770-824-5395
Mailing Address - Fax:706-802-5071
Practice Address - Street 1:516 YOUNGS FARM RD
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-5894
Practice Address - Country:US
Practice Address - Phone:770-824-5395
Practice Address - Fax:706-802-5071
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator