Provider Demographics
NPI:1609888312
Name:WILLE, MARIANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:WILLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 ST. ANDREWS ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210
Mailing Address - Country:US
Mailing Address - Phone:803-358-6160
Mailing Address - Fax:803-407-4101
Practice Address - Street 1:7035 ST. ANDREWS ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:803-358-6160
Practice Address - Fax:803-407-4101
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC006282Medicaid
SC006282Medicaid