Provider Demographics
NPI:1841265410
Name:WILLIARD, JULIE (RN FNP C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WILLIARD
Suffix:
Gender:F
Credentials:RN FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 DALLAS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1264
Mailing Address - Country:US
Mailing Address - Phone:770-459-0620
Mailing Address - Fax:770-456-7604
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1264
Practice Address - Country:US
Practice Address - Phone:770-459-0620
Practice Address - Fax:770-456-7604
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN086758NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00812578Medicaid
50BBDMNMedicare ID - Type Unspecified
GA00812578Medicaid