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General NPI Number Information
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NPI Number | 1588695092
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Entity Type | Individual
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Provider Name | JOSE RAMON VILLAMIL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 515 B CITY BOULEVARD WAYCROSS VA OUTREACH CLINIC
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City | WAYCROSS
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State | GA
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Zip | 31501
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Country | US
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Telephone | 912-279-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 515 B CITY BOULEVARD WAYCROSS VA OUTREACH CLINIC
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City | WAYCROSS
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State | GA
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Zip | 31501
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Country | US
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Telephone | 912-279-4400
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 16389
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License Number State | PR
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