Healthcare Provider Details

I. General information

NPI: 1477614246
Provider Name (Legal Business Name): AMY MARIE WELLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E 3RD ST
CHATTANOOGA TN
37403-2101
US

IV. Provider business mailing address

900 E 3RD ST
CHATTANOOGA TN
37403-2101
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-5437
  • Fax: 423-778-7507
Mailing address:
  • Phone: 423-778-5437
  • Fax: 423-778-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59753
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0075513
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101242087
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: