Provider Demographics
NPI:1124493416
Name:WELLS, CHAUNEECY
Entity type:Individual
Prefix:
First Name:CHAUNEECY
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHAUNEECY
Other - Middle Name:
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9703 IVEY RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-4158
Mailing Address - Country:US
Mailing Address - Phone:216-334-9739
Mailing Address - Fax:
Practice Address - Street 1:9703 IVEY RIDGE CIR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-4158
Practice Address - Country:US
Practice Address - Phone:216-334-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH127669Medicaid