Healthcare Provider Details

I. General information

NPI: 1669393849
Provider Name (Legal Business Name): SAMANTHA RILEY WELLS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RILEY WELLS FNP

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 EATONTON RD
MADISON GA
30650-4627
US

IV. Provider business mailing address

492 POPLAR ST
MADISON GA
30650-1622
US

V. Phone/Fax

Practice location:
  • Phone: 706-438-6486
  • Fax:
Mailing address:
  • Phone: 706-438-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP308787
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: