Provider Demographics
NPI:1962698266
Name:WELLS, JULIA ELYSE (PA-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ELYSE
Last Name:WELLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ELYSE
Other - Last Name:GODLESKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-373-0212
Mailing Address - Fax:704-373-1249
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5863
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:704-372-1249
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05372363AS0400X
NC0010-03451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102369Medicaid
SC1436PAMedicaid
NC1962698266Medicaid
NC8102369Medicaid