Provider Demographics
NPI:1972609576
Name:WELLS, JAMES SHELTON JR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:SHELTON
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5024 BOULDER RUN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8301
Mailing Address - Country:US
Mailing Address - Phone:919-967-6353
Mailing Address - Fax:919-933-6333
Practice Address - Street 1:5024 BOULDER RUN RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8301
Practice Address - Country:US
Practice Address - Phone:919-967-6353
Practice Address - Fax:919-933-6333
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC229902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03601771411OtherME #
NC34599OtherAPA #
27605OtherPSYCHIATRY BOARD CERT
VA32646OtherSTATE MEDICAL LICENSE
NC8986484Medicaid
NC22990OtherSTATE MEDICAL LICENSE
NC86484OtherBCBS
NC03601771411OtherME #
NC22990OtherSTATE MEDICAL LICENSE