Individual
MR. KENJI JERMAINE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8331 BLUE RIDGE DR, SOUTHAVEN, MS 38672-6589
(901) 857-5961
Mailing address
8331 BLUE RIDGE DR, SOUTHAVEN, MS 38672-6589
(901) 857-5961
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
082851399
TN
Other
Enumeration date
06/09/2023
Last updated
06/14/2023
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