Provider Demographics
NPI:1881362424
Name:WELLS, EMILY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8202 WALDEN CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9543
Mailing Address - Country:US
Mailing Address - Phone:770-584-9673
Mailing Address - Fax:
Practice Address - Street 1:4550 COBB PARKWAY NORTH NW STE 101
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4181
Practice Address - Country:US
Practice Address - Phone:470-956-0100
Practice Address - Fax:770-529-0279
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA10527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty