1194799965 NPI number — WILLIAM A WELLS MD

Table of content: WILLIAM A WELLS MD (NPI 1194799965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194799965 NPI number — WILLIAM A WELLS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLS
Provider First Name:
WILLIAM
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194799965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4711 SUNSET BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29072-9151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-626-9164
Provider Business Mailing Address Fax Number:
803-426-3589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4711 SUNSET BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29072-9151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-626-9164
Provider Business Practice Location Address Fax Number:
803-426-3589
Provider Enumeration Date:
02/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X , with the licence number:  045664 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000795286F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5110650 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4492627005 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040015831 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 157315300 . This is a "EMPLYMENT STANDARD WORKER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 245524 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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