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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MS | 06927265 | 05 |
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 |
Street Address |
103 MEDICAL PARK |
City | HATTIESBURG |
State | MS |
Zip Code | 39401-9042 |
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 |
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 Code | 207QS0010X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Sports Medicine |
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. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649470147 | Nathan Chambers Darby | Family Medicine | 103 Tatum Park, Hattiesburg, MS 39401 | 2007-07-23 |
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 |
City | HATTIESBURG |
Zip Code | 39401 |
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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.