Provider Demographics
NPI:1457878662
Name:WELLS, THERON WAYNE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THERON
Middle Name:WAYNE
Last Name:WELLS
Suffix:JR
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 1:207 ASPHODEL DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2984
Mailing Address - Country:US
Mailing Address - Phone:334-793-9420
Mailing Address - Fax:
Practice Address - Street 1:207 ASPHODEL DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2984
Practice Address - Country:US
Practice Address - Phone:334-793-9420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty