Provider Demographics
NPI:1316012735
Name:WELLS, JAMES LEROY JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEROY
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1595 CAROLINA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4940
Mailing Address - Country:US
Mailing Address - Phone:803-534-3092
Mailing Address - Fax:803-531-4698
Practice Address - Street 1:1595 CAROLINA AVENUE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4940
Practice Address - Country:US
Practice Address - Phone:803-534-3092
Practice Address - Fax:803-531-4698
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC7836207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC078365Medicaid
SC078365Medicaid
D99240Medicare UPIN