Healthcare Provider Details

I. General information

NPI: 1538169115
Provider Name (Legal Business Name): WILLARD ALEXANDER SNYDER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 STARLING ST
BRUNSWICK GA
31520-4215
US

IV. Provider business mailing address

2314 STARLING ST
BRUNSWICK GA
31520-4215
US

V. Phone/Fax

Practice location:
  • Phone: 912-265-9900
  • Fax: 912-265-2074
Mailing address:
  • Phone: 912-265-9900
  • Fax: 912-265-2074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number032304
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: