=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942545538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAWEY ADOLPHUS WELLS JR. M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2012
-----------------------------------------------------
Last Update Date | 12/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 RAINBOW DR
-----------------------------------------------------
City | KEY LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33037-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-453-5382
-----------------------------------------------------
Fax | 305-453-5382
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 853 COMSTOCK DR
-----------------------------------------------------
City | SHEPHERDSTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25443-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-671-5531
-----------------------------------------------------
Fax | 305-453-5382
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 08411
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------