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General NPI Number Information
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NPI Number | 1982798310
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Entity Type | Individual
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Provider Name | TONY L. WILLSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 1310 COUNTY ROAD 210 W
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City | ST JOHNS
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State | FL
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Zip | 32259-1183
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Country | US
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Telephone | 904-824-4407
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Fax | 904-390-7459
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Provider Business Mailing Address
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Address Line | PO BOX 746638
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City | ATLANTA
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State | GA
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Zip | 30374-6638
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Country | US
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Telephone | 904-202-1032
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Fax | 904-376-4107
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0052091
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME97817
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License Number State | FL
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