Healthcare Provider Details

I. General information

NPI: 1588771067
Provider Name (Legal Business Name): MICHAEL ANTHONY WELLS R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S GREEN ST
SWAINSBORO GA
30401-3131
US

IV. Provider business mailing address

104 S GREEN ST
SWAINSBORO GA
30401-3131
US

V. Phone/Fax

Practice location:
  • Phone: 478-237-8835
  • Fax: 478-237-9510
Mailing address:
  • Phone: 478-237-8835
  • Fax: 478-237-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number016582
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: