Individual
ASHLEY CAROLINE WYATT WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2283 WRIGHTSBORO RD, AUGUSTA, GA 30904-4717
(706) 733-3373
(706) 733-3423
Mailing address
2400 BELLEVUE RD STE 21A, DUBLIN, GA 31021-2890
(478) 275-7202
(478) 274-8418
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
005983
GA
363AM0700X
Medical Physician Assistant
Primary
005983
GA
363AS0400X
Surgical Physician Assistant
005983
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003101516
—
GA
01
—
005983
GEORGIA LICENSE
GA
Enumeration date
10/28/2010
Last updated
03/11/2015
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