Provider Demographics
NPI:1740024983
Name:WELLS, ETHAN CHARLES (PA-C)
Entity type:Individual
Prefix:MR
First Name:ETHAN
Middle Name:CHARLES
Last Name:WELLS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-893-2400
Mailing Address - Fax:336-893-2410
Practice Address - Street 1:7210 VILLAGE MEDICAL CIR STE 110
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8041
Practice Address - Country:US
Practice Address - Phone:336-893-2400
Practice Address - Fax:336-893-2410
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-10-17
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Provider Licenses
StateLicense IDTaxonomies
NC1219652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant