JEREMY BLAKE WELLS


Address: 103 Medical Park, Hattiesburg, MS 39401-9042
Phone: 6012685630

JEREMY BLAKE WELLS (NPI# 1144517822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1144517822
Entity Type Individual
Full Name JEREMY BLAKE WELLS
Credential M.D.
Practice Address 103 Medical Park
Hattiesburg
MS 39401-9042
Mailing Address 415 S 28th Ave
Hattiesburg
MS 39401-7246
Practice Telephone 6012685630
Practice Fax Number 6012685819
Mailing Telephone 6012685630
Mailing Fax Number 6015795240
Enumeration Date 2011-07-01
Last Update Date 2020-07-21
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207Q00000X Family Medicine T-2501 MS Allopathic & Osteopathic Physicians
Y 207QS0010X Family Medicine
Specialization: Sports Medicine
22493 MS Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
MS 06927265 05

Other Providers JEREMY WELLS

NPI Name Taxonomy Address Enumeration
1861879181 Jeremy Wells Community Health Worker 1001 Potrero Avenue 6b, San Francisco, CA 94110 2015-05-06
1124658422 Jeremy Scott Wells Registered Nurse 1506 S Oneida St, Appleton, WI 54915-1305 2020-01-25
1982167342 Jeremy David Wells Student in an Organized Health Care Education/Training Program 101 Manning Dr, Chapel Hill, NC 27514-4220 2019-04-11
1982119111 Jeremy Lee Wells Counselor 132 Cass Ave, Mount Clemens, MI 48043-2230 2017-12-11
1215448436 Jeremy Wells Pharmacist 1030 W 21st St, South Sioux City, NE 68776-2661 2017-10-15
1114470580 Jeremy Mantle Wells Dentist 49th Medical Group/sgpd, 280 First Street, Bldg 23, Holloman Afb, NM 88330-8273 2016-08-02
1164694881 Jeremy B. Wells Anesthesiology 1740 Nicholasville Rd, Lexington, KY 40503-1431 2008-04-02
1285831677 Jeremy Clady Wells Internal Medicine 1303 Dantignac St Ste 1000, Augusta, GA 30901-2776 2007-06-28

Office Location

Street Address 103 MEDICAL PARK
City HATTIESBURG
State MS
Zip Code 39401-9042

Providers in the same location

NPI Name Taxonomy Address Enumeration
1821102740 Robert Clint Hudson Physical Therapist 103 Medical Park, Hattiesburg, MS 39401-9042 2006-08-18
1407470990 Hattiesburg Clinic, Pa Physical Medicine & Rehabilitation 103 Medical Park, Hattiesburg, MS 39401-9042 2020-06-01
1811548696 Lauren Mckenzy Reynolds Physical Therapist 103 Medical Park, Hattiesburg, MS 39401-9042 2019-09-24
1962051946 John Reynolds Clark Physical Therapist 103 Medical Park, Hattiesburg, MS 39401-9042 2019-09-11
1821655150 Nancy Danielle Lewis Physical Therapist 103 Medical Park, Hattiesburg, MS 39401-9042 2019-05-22
1255869665 Jennifer Lacroix Gunther Nurse Practitioner 103 Medical Park, Hattiesburg, MS 39401-9042 2017-05-30
1518347681 John Michael Porter Occupational Therapist 103 Medical Park, Hattiesburg, MS 39401-9042 2015-06-04
1306254255 Jessica Mccallister Tullos Emergency Medicine 103 Medical Park, Hattiesburg, MS 39401-9042 2014-07-23
1063848075 Rowdy Chance Lee Physician Assistant 103 Medical Park, Hattiesburg, MS 39401-9042 2013-09-23
1689908352 Shawn Fayard Specialist/Technologist 103 Medical Park, Hattiesburg, MS 39401-9042 2009-09-28
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1598315863 Lisa Thornton Technician 18 Timberline Dr., Hattiesburg, MS 39401 2019-09-18
1548813637 Caroline Estes Barnes Counselor Barnes, 8 App Slade Road, Hattiesburg, MS 39401 2019-07-18
1396252441 Selection Healthcare Services, LLC In Home Supportive Care 606 Adeline St Ste 1c, Hattiesburg, MS 39401 2018-01-10
1225545585 Whitney Wilkinson Nurse Practitioner 301 South 28th Avenue, Hattiesburg, MS 39401 2018-01-08
1740795806 Forrest General Hospital Pharmacy 1414 South 28th Avenue, Hattiesburg, MS 39401 2017-12-11
1275058455 Casey Payne Pharmacist 6130 Us 49, Hattiesburg, MS 39401 2017-08-08
1225562705 Sarah Marie Hudson Family Medicine 6051 Us Highway 49 S, Hattiesburg, MS 39401 2017-04-12
1043671704 The Covington's Cove Assisted Living Center LLC Assisted Living Facility 192 Mary Magdalene Church Rd, Hattiesburg, MS 39401 2016-03-09
1780083626 Dominique Reed Watson Pharmacist 602 Adeline St, Hattiesburg, MS 39401 2014-08-15
1558778936 Willie Davis Jr. Day Training, Developmentally Disabled Services 701 Duke Ave., Hattiesbiurg, MS 39401 2014-07-17
Find all providers in zip 39401

Taxonomy Information

Taxonomy Code 207QS0010X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Sports Medicine

Taxonomy Definition

A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1649470147 Nathan Chambers Darby Family Medicine 103 Tatum Park, Hattiesburg, MS 39401 2007-07-23

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1134769938 Micah Mckee Family Medicine 416 Geeslin Rd, Grenada, MS 38901-8647 2020-01-09
1548659097 Copiah Lincoln Community College Family Medicine 1028 Jc Redd Dr, Wesson, MS 39191-5020 2015-01-21
1417002965 Henry Lowell Sherman Family Medicine 7545 Airways Blvd, Southaven, MS 38671-5806 2007-01-24
1306942297 Nahum M Beard Family Medicine 7545 Airways Blvd, Southaven, MS 38671-5806 2006-09-16

Competitor

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City HATTIESBURG
Zip Code 39401

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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