Wells, Jeremy Blake

Wells, Jeremy Blake is an individual health care provider with primary practice located at 103 Medical Park Fl 2 , Hattiesburg MS 39401-9042. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Wells, Jeremy Blake can be contacted via phone (601) 268-5630.

Contact Information

Primary practice address
103 Medical Park Fl 2 Hattiesburg MS 39401-9042
Phone: (601) 268-5630
Fax: (601) 579-3285
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 22493 Mississippi
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X T-2501 Mississippi

Profile Details

NPI number 1144517822
LBN Legal business name Wells, Jeremy Blake
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 1st, 2011
Last updated May 9th, 2024 - about 7 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144517822 NPPES
Mississippi MEDICAID 06927265

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