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1467691402

NPI Code Detail

MEDICARE: MISS PAULA SUZANNE WILLIS PA-C

MEDICARE: MISS PAULA SUZANNE WILLIS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	003144	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01110461	OTHER	GA	RAILROAD MEDICARE
7	P01036869	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467691402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAULA SUZANNE WILLIS PA-C

Provider Business Mailing Address
First Line	:	14089 ABERCORN ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31419-1966
Country	:	US
Telephone Number	:	912-350-2121
Fax Number	:	912-350-2145

Provider Business Practice Location Address
First Line	:	14089 ABERCORN ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31419-1966
Country	:	US
Telephone Number	:	912-350-2121
Fax Number	:	912-350-2145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2009
Last Update Date	:	09/12/2014

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Directions to “ MISS PAULA SUZANNE WILLIS PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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