Provider Demographics
NPI:1528574837
Name:MAPP, WILLIE (RN)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:
Last Name:MAPP
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 VANCEVILLE COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-9169
Mailing Address - Country:US
Mailing Address - Phone:229-388-1354
Mailing Address - Fax:
Practice Address - Street 1:92 VANCEVILLE COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-9169
Practice Address - Country:US
Practice Address - Phone:229-388-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129250163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse