MEDICARE: MR. JAMIE WELLS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN140888	GA

General Provider Information

NPI Number	:	1568881217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMIE WELLS FNP-BC

Provider Business Mailing Address
First Line	:	460 MALL BLVD
Second Line	:	STE B
City	:	SAVANNAH
State	:	GA
Zip	:	31406-4801
Country	:	US
Telephone Number	:	912-644-5300
Fax Number	:	912-644-3369

Provider Business Practice Location Address
First Line	:	7300 GA HIGHWAY 21
Second Line	:
City	:	PORT WENTWORTH
State	:	GA
Zip	:	31407-9205
Country	:	US
Telephone Number	:	912-964-1797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	03/17/2017

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