Provider Demographics
NPI:1871986331
Name:WELLS, TIERRA SIMONE (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:TIERRA
Middle Name:SIMONE
Last Name:WELLS
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:TIERRA
Other - Middle Name:SIMONE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:275 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7349
Mailing Address - Country:US
Mailing Address - Phone:770-474-8400
Mailing Address - Fax:770-474-3738
Practice Address - Street 1:275 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7349
Practice Address - Country:US
Practice Address - Phone:770-474-8400
Practice Address - Fax:770-474-3738
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216891363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN216891OtherGA LICENSE
GA003161959HMedicaid