Provider Demographics
NPI:1841289154
Name:WELLS, JOHN A III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:WELLS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:124 SUNSET COURT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-931-0077
Mailing Address - Fax:803-931-0076
Practice Address - Street 1:124 SUNSET COURT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-931-0077
Practice Address - Fax:803-931-0076
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15565207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0623Medicaid
SCF29039Medicare UPIN
SCF290394245Medicare PIN