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Organization
WHEELER COUNTY FAMILY MEDICINE
Active
Organization
WHEELER COUNTY FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ODELL P STILL D.O. (MEDICAL DIRECTOR)
(912) 537-0616
Entity
Organization
Contact information
Practice address
104 MAPLE DR, VIDALIA, GA 30474-8949
(912) 537-0616
(912) 537-0617
Mailing address
104 MAPLE DR, VIDALIA, GA 30474-8949
(912) 537-0616
(912) 537-0617
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
037085
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000347751C
—
GA
05
—
000539624E
—
GA
05
—
000539624K
—
GA
05
—
000631474A
—
GA
05
—
000954533C
—
GA
05
—
091222821A
—
GA
05
—
393478520A
—
GA
05
—
644701462A
—
GA
Enumeration date
06/20/2007
Last updated
02/03/2010
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