Basic Information
| Provider Information | |||||||||
| NPI: | 1225246192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | RAZOR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365B CLIFTON RD NE, | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785163 | ||||||||
| FaxNumber: | 4047784434 | ||||||||
| Practice Location | |||||||||
| Address1: | 1365B CLIFTON RD NE, | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785163 | ||||||||
| FaxNumber: | 4047784434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 27600 | AL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 62451 | GA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.