Provider Demographics
NPI:1841567922
Name:WILLETS, ELIZABETH HARRILL (CNMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HARRILL
Last Name:WILLETS
Suffix:
Gender:F
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2370 BEXFORD VW
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7294
Mailing Address - Country:US
Mailing Address - Phone:770-490-7919
Mailing Address - Fax:
Practice Address - Street 1:2370 BEXFORD VW
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7294
Practice Address - Country:US
Practice Address - Phone:770-490-7919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001837204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM