Provider Demographics
NPI:1366481723
Name:HILLSON, WILLIE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:JOSEPH
Last Name:HILLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 GORDON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5496
Mailing Address - Country:US
Mailing Address - Phone:706-736-3210
Mailing Address - Fax:706-736-2674
Practice Address - Street 1:2045 GORDON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5496
Practice Address - Country:US
Practice Address - Phone:706-736-3210
Practice Address - Fax:706-736-2674
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG20737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00180155BMedicaid
GA00180155BMedicaid