# MEDIPRACTIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medipractic Pain Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699834697
- **Authorized official:** DR. WILLIAM E WILLIS DC CDE1 DAAPM (SEC)
- **Authorized official phone:** (770) 496-0326

## Contact information

- **Practice address:** 3955 HARRISON RD, STE. 400, LOGANVILLE, GA 30052-8501
- **Practice address phone:** (770) 496-0326
- **Practice address fax:** (770) 492-9599
- **Mailing address:** 3955 HARRISON RD, STE. 400, LOGANVILLE, GA 30052-8501
- **Mailing address phone:** (770) 496-0326
- **Mailing address fax:** (770) 492-9599

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | NULL | Yes |
| 204C00000X | Sports Medicine (Neuromusculoskeletal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2006
- **Last updated:** 12/21/2012