Healthcare Provider Details

I. General information

NPI: 1679334288
Provider Name (Legal Business Name): NIA PATRICE WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TOWNPARK LN NW
KENNESAW GA
30144-5579
US

IV. Provider business mailing address

877 MADISON AVE
MEMPHIS TN
38103-3408
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM003974
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: