Individual
GROVER ASHTON WELLS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 MEDICAL PARK DR, SUITE 106, ANDALUSIA, AL 36420-5316
(334) 222-4191
(334) 222-9069
Mailing address
PO BOX 158, ANDALUSIA, AL 36420-1202
(334) 222-4191
(334) 222-9069
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
23300
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009926920
—
AL
01
—
51094943
BLUE CROSS BLUE SHIELD AL
AL
01
—
51097094
BLUE CROSS BLUE SHIELD AL
AL
Enumeration date
05/31/2006
Last updated
05/20/2008
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