MEDICARE: DR. JOE TERRELL WILLS 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	208600000X	Surgery Physician	033003	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	:	1770523318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOE TERRELL WILLS M.D.

Provider Business Mailing Address
First Line	:	462 MOUNT PLEASANT RD
Second Line	:	PO BOX 1148
City	:	THOMSON
State	:	GA
Zip	:	30824-8123
Country	:	US
Telephone Number	:	706-595-9950
Fax Number	:	706-597-8820

Provider Business Practice Location Address
First Line	:	462 MT PLEASANT RD
Second Line	:
City	:	THOMSON
State	:	GA
Zip	:	30824-8123
Country	:	US
Telephone Number	:	706-595-9950
Fax Number	:	706-597-8820

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/18/2010

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