Provider Demographics
NPI:1720631088
Name:5AM P.C.
Entity Type:Organization
Organization Name:5AM P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TERRANCE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-320-3880
Mailing Address - Street 1:475 HANSELL ST SE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-3071
Mailing Address - Country:US
Mailing Address - Phone:713-859-2854
Mailing Address - Fax:
Practice Address - Street 1:475 HANSELL ST SE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-3071
Practice Address - Country:US
Practice Address - Phone:713-859-2854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty