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General NPI Number Information
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NPI Number | 1316159676
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Entity Type | Individual
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Provider Name | JASON TERRANCE WELLS MD
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 316 N BROAD ST
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City | WINDER
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State | GA
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Zip | 30680-2150
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Country | US
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Telephone | 770-867-3400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 742616
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City | ATLANTA
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State | GA
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Zip | 30374-2616
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Country | US
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Telephone | 770-219-8420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301110953
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 81174
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License Number State | GA
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