Healthcare Provider Details

I. General information

NPI: 1568881217
Provider Name (Legal Business Name): JAMIE WELLS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GA HIGHWAY 21
PORT WENTWORTH GA
31407-9205
US

IV. Provider business mailing address

460 MALL BLVD STE B
SAVANNAH GA
31406-4801
US

V. Phone/Fax

Practice location:
  • Phone: 912-964-1797
  • Fax:
Mailing address:
  • Phone: 912-644-5300
  • Fax: 912-644-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN140888
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: