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Individual

DR. CHARLES CHESLEY WELLS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
435 2ND ST, 430, MACON, GA 31201-8298
(478) 745-5779
(478) 742-7796
Mailing address
200 CORPORATE PL, 5B, PEABODY, MA 01960-3840
(978) 536-7400
(978) 536-6141

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
D19807
GA
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
Primary
019807
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000260246G
GA
05
000260246H
GA
05
000260246I
GA
05
000260246J
GA
05
000260246K
GA
01
915875
BLUE CROSS
Enumeration date
07/21/2006
Last updated
06/07/2012
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