Provider Demographics
NPI:1649254210
Name:WELLMAN, SAMUEL DAVIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DAVIS
Last Name:WELLMAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:352 2ND ST NW SUITE 205
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1305
Mailing Address - Country:US
Mailing Address - Phone:828-345-0877
Mailing Address - Fax:828-345-0514
Practice Address - Street 1:352 2ND ST NW
Practice Address - Street 2:SUITE 205
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4960
Practice Address - Country:US
Practice Address - Phone:828-345-0877
Practice Address - Fax:828-345-0514
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2016-03-14
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Provider Licenses
StateLicense IDTaxonomies
NC94-013612080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986457Medicaid
NC8986457Medicaid