Provider Demographics
NPI:1558691881
Name:GREGORY A. WILETS, M.D. P.C.
Entity Type:Organization
Organization Name:GREGORY A. WILETS, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-244-7310
Mailing Address - Street 1:1111 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-8748
Mailing Address - Country:US
Mailing Address - Phone:720-244-7310
Mailing Address - Fax:
Practice Address - Street 1:1111 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:TYBEE ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31328-8748
Practice Address - Country:US
Practice Address - Phone:720-244-7310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0608932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty