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General NPI Number Information
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NPI Number | 1154344737
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Entity Type | Individual
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Provider Name | DONALD ROGER WILLERS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 655 JESSE JEWELL PKWY SE STE B
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City | GAINESVILLE
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State | GA
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Zip | 30501-3854
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Country | US
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Telephone | 770-532-7092
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Fax | 770-536-0383
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Provider Business Mailing Address
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Address Line | PO BOX 658
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City | GAINESVILLE
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State | GA
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Zip | 30503-0658
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Country | US
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Telephone | 770-718-1122
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Fax | 770-535-7445
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 017748
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License Number State | GA
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