Provider Demographics
NPI:1699425736
Name:WELLS, LAWANDA (DIRECTOR)
Entity type:Individual
Prefix:
First Name:LAWANDA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 TIPPERARY RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2348
Mailing Address - Country:US
Mailing Address - Phone:347-737-4041
Mailing Address - Fax:678-210-8850
Practice Address - Street 1:669 TIPPERARY RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2348
Practice Address - Country:US
Practice Address - Phone:347-737-4041
Practice Address - Fax:678-210-8850
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker