Healthcare Provider Details

I. General information

NPI: 1801869482
Provider Name (Legal Business Name): JENNIFER C. WELLS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PRINCE AVE STE. 202 E
ATHENS GA
30606-5811
US

IV. Provider business mailing address

1010 PRINCE AVE STE. 202 E
ATHENS GA
30606-5811
US

V. Phone/Fax

Practice location:
  • Phone: 706-548-7373
  • Fax: 706-548-8088
Mailing address:
  • Phone: 706-548-7373
  • Fax: 706-548-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number011577
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: