Healthcare Provider Details

I. General information

NPI: 1174205694
Provider Name (Legal Business Name): HANNAH DAVIS WILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NORTHSIDE DR
VALDOSTA GA
31602-1858
US

IV. Provider business mailing address

235 PARKS MEMORIAL BUILDING CAMPUS BOX 63
MILLEDGEVILLE GA
31061
US

V. Phone/Fax

Practice location:
  • Phone: 229-241-2800
  • Fax:
Mailing address:
  • Phone: 478-445-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN277815
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN277815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: