Organization
CHARLES C WELLS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES C WELLS (MD)
(978) 536-7400
Entity
Organization
Contact information
Practice address
770 HEMLOCK ST, MACON, GA 31201-2170
(478) 745-5125
Mailing address
60 CHASTAIN CENTER BLVD NW, SUITE 66, KENNESAW, GA 30144-5598
(978) 536-7400
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
915875
BLUE CROSS
—
Enumeration date
07/23/2007
Last updated
08/24/2007
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