Healthcare Provider Details

I. General information

NPI: 1841108354
Provider Name (Legal Business Name): TIMOTHY WILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 S 3RD ST
NEWARK OH
43055-5335
US

IV. Provider business mailing address

112 S 3RD ST
NEWARK OH
43055-5335
US

V. Phone/Fax

Practice location:
  • Phone: 740-345-6874
  • Fax: 740-345-5157
Mailing address:
  • Phone: 740-345-6874
  • Fax: 740-345-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.008265
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: