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General NPI Number Information
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NPI Number | 1679660799
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Entity Type | Individual
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Provider Name | MARCIA L. WILLS MD
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Gender | Female
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 11/16/2024
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Provider Practice Location Address
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Address Line | 333 BORTHWICK AVE DEPT OF
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City | PORTSMOUTH
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State | NH
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Zip | 03801-7128
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Country | US
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Telephone | 603-433-4907
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Fax | 603-433-4910
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Provider Business Mailing Address
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Address Line | PO BOX 745745
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City | ATLANTA
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State | GA
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Zip | 30374-5745
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Country | US
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Telephone | 603-433-4907
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Fax | 603-433-4910
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 018544
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 042.0013462
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 33230
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License Number State | NH
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Taxonomy #4
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD39313
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 244652
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License Number State | MA
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