Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 74796 | GA |
NPI | 1033103916 |
---|---|
Provider Name | Dr. Michael Roy Willman |
First Address | Snellville, GA 30078-3232 |
Second Address | Snellville, GA 30078-3232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2005 |
Last Update Date | 19/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003171727A | (05) | GA |