Healthcare Provider Details

I. General information

NPI: 1831119791
Provider Name (Legal Business Name): JOHN W. WELLS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5379
  • Fax: 740-446-5883
Mailing address:
  • Phone: 740-446-5379
  • Fax: 740-446-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: