Provider Demographics
NPI:1588754535
Name:WELLS, PAMELA A (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-425-5783
Practice Address - Street 1:145 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3019
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-422-0329
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD457822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518378Medicaid
TN1518378Medicaid
TN103I309643Medicare PIN