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General NPI Number Information
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NPI Number | 1760653612
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Entity Type | Individual
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Provider Name | WILLIE E LANDRUM II MD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 600 CELEBRATE LIFE PKWY
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City | NEWNAN
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State | GA
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Zip | 30265-8001
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Country | US
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Telephone | 847-342-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 4480 S COBB DR SE STE H
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City | SMYRNA
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State | GA
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Zip | 30080-6964
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Country | US
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Telephone | 678-542-7256
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 059265
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License Number State | GA
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