Provider Demographics
NPI:1851436646
Name:WELLS, GERAME TATE (MD)
Entity type:Individual
Prefix:
First Name:GERAME
Middle Name:TATE
Last Name:WELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 KENTON ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1981
Mailing Address - Country:US
Mailing Address - Phone:270-632-4555
Mailing Address - Fax:270-632-4556
Practice Address - Street 1:1724 KENTON ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1981
Practice Address - Country:US
Practice Address - Phone:270-632-4555
Practice Address - Fax:270-632-4556
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40461208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000513785OtherANTHEM
KY7100003070Medicaid
KY7100003070Medicaid