Individual
MR. ETHAN CHARLES WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7210 VILLAGE MEDICAL CIR STE 110, CLEMMONS, NC 27012-8041
(336) 893-2400
(336) 893-2410
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 893-2400
(336) 893-2410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1219652
NC
Other
Enumeration date
06/22/2024
Last updated
10/17/2024
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