Provider Demographics
NPI:1740284520
Name:WILLS, JANET (NP)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:WILLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MOCCASIN LN
Mailing Address - Street 2:
Mailing Address - City:FORT GAINES
Mailing Address - State:GA
Mailing Address - Zip Code:39851-2122
Mailing Address - Country:US
Mailing Address - Phone:229-768-2476
Mailing Address - Fax:229-732-6528
Practice Address - Street 1:208 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-1335
Practice Address - Country:US
Practice Address - Phone:229-732-3721
Practice Address - Fax:229-732-6528
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-10-29
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
GAGAR037924363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS52433Medicare UPIN
GA50BBCGFMedicare ID - Type Unspecified