Provider Demographics
NPI:1518051077
Name:WILL, SCOTT JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOSEPH
Last Name:WILL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 STATE ROUTE 49
Mailing Address - Street 2:
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-9604
Mailing Address - Country:US
Mailing Address - Phone:419-315-0568
Mailing Address - Fax:
Practice Address - Street 1:6802 PARAGON PL STE 410
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1655
Practice Address - Country:US
Practice Address - Phone:901-271-9500
Practice Address - Fax:901-271-9501
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant