MEDICARE: NATHAN LEWIS WILLS

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1568967016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN LEWIS WILLS

Provider Business Mailing Address
First Line	:	PO BOX 7136
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29572-0007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 AZALEA DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29575-8240
Country	:	US
Telephone Number	:	843-712-1225
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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Directions to “ NATHAN LEWIS WILLS ” Practice Location

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