Healthcare Provider Details

I. General information

NPI: 1215223276
Provider Name (Legal Business Name): ROBERT GEORGE WILLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 JENNINGS MILL RD BLDG 300-110
WATKINSVILLE GA
30677-7238
US

IV. Provider business mailing address

UCONN MUSCULOSKELETAL INSTITUTE 263 FARMINGTON AVENUE
FARMINGTON CT
06030-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-5880
  • Fax:
Mailing address:
  • Phone: 860-679-6645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number078469
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number078469
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number55724
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: