Provider Demographics
NPI:1346068533
Name:WELLS, MICHAEL BRYAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRYAN
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 E LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3738
Mailing Address - Country:US
Mailing Address - Phone:229-928-8355
Mailing Address - Fax:229-928-8358
Practice Address - Street 1:618 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3738
Practice Address - Country:US
Practice Address - Phone:229-928-8355
Practice Address - Fax:229-928-8358
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily