Provider Demographics
NPI:1124014592
Name:STILL, WILLIE EVERETT JR (R PH)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:EVERETT
Last Name:STILL
Suffix:JR
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CAMERONS WAY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-1160
Mailing Address - Country:US
Mailing Address - Phone:678-232-5665
Mailing Address - Fax:
Practice Address - Street 1:40 CAMERONS WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-1160
Practice Address - Country:US
Practice Address - Phone:678-232-5665
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist