Healthcare Provider Details

I. General information

NPI: 1285838243
Provider Name (Legal Business Name): LAURA SUE WILLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 E STATE ST
ATHENS OH
45701-2138
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1560
US

V. Phone/Fax

Practice location:
  • Phone: 855-446-5937
  • Fax: 740-566-4014
Mailing address:
  • Phone: 740-446-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.095134
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: