Basic Information
| Provider Information | |||||||||
| NPI: | 1740284520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLS | ||||||||
| FirstName: | JANET | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MOCCASIN LN | ||||||||
| Address2: | |||||||||
| City: | FORT GAINES | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398512122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2297682476 | ||||||||
| FaxNumber: | 2297326528 | ||||||||
| Practice Location | |||||||||
| Address1: | 208 MCDONALD AVE | ||||||||
| Address2: | |||||||||
| City: | CUTHBERT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 398401335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2297323721 | ||||||||
| FaxNumber: | 2297326528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/15/2006 | ||||||||
| NPIReactivationDate: | 03/29/2006 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | GAR037924 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.