MEDICARE: DR. NOAH E WILLS III M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	039014	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124015938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOAH E WILLS III M.D.

Provider Business Mailing Address
First Line	:	4166 SNAPFINGER WOODS DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-3411
Country	:	US
Telephone Number	:	404-284-3200
Fax Number	:	404-288-1745

Provider Business Practice Location Address
First Line	:	4166 SNAPFINGER WOODS DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-3411
Country	:	US
Telephone Number	:	404-284-3200
Fax Number	:	404-288-1745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	04/01/2009

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