MEDICARE: DR. EDDIE Q WILLIS DMD

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	1223G0001X	General Practice Dentistry	DN123207	GA

General Provider Information

NPI Number	:	1588439426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDIE Q WILLIS DMD

Provider Business Mailing Address
First Line	:	313 MOOTY BRIDGE RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-1809
Country	:	US
Telephone Number	:	706-837-0123
Fax Number	:	706-668-5100

Provider Business Practice Location Address
First Line	:	313 MOOTY BRIDGE RD
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30240-1809
Country	:	US
Telephone Number	:	706-837-0123
Fax Number	:	706-668-5100

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

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

Similar Medicare Providers

1568280519 — CHILDREN AND TEEN DENTAL GROUP
Practice Location Address:

313 MOOTY BRIDGE RD STE 202
LAGRANGE, GA
30240-1809

Practice Phone: 706-837-0123
Practice Fax:

1265603963 — DR. TARA W MILLIGAN DDS
Practice Location Address:

313 MOOTY BRIDGE RD
LAGRANGE, GA
30240-1809

Practice Phone: 706-837-0123
Practice Fax: 706-884-2649

1619539814 — DR. KATHLEEN RUTH FADLER DMD
Practice Location Address:

313 MOOTY BRIDGE RD STE 202
LAGRANGE, GA
30240-1809

Practice Phone: 706-837-0123
Practice Fax:

1275195497 — DR. GARY TYRONE BISHOP DMD
Practice Location Address:

313 MOOTY BRIDGE RD STE 202
LAGRANGE, GA
30240-1809

Practice Phone: 706-837-0123
Practice Fax:

1639977820 — CHATTAHOOCHEE FAMILY ORTHODONTICS
Practice Location Address:

313 MOOTY BRIDGE RD STE 202
LAGRANGE, GA
30240-1809

Practice Phone: 706-837-0123
Practice Fax:

1629994801 — SIMPLY LOVE
Practice Location Address:

2170 W POINT RD STE 8
LAGRANGE, GA
30240-4008

Practice Phone: 706-756-2552
Practice Fax:

Directions to “ DR. EDDIE Q WILLIS DMD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.