Individual
PAUL D WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
3131 PIO NONO AVE, MACON, GA 31206-3027
(478) 781-2818
(478) 746-9865
Mailing address
3131 PIO NONO AVE, MACON, GA 31206-3027
(478) 781-2818
(478) 746-9865
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
LDO001314
GA
Other
Enumeration date
07/07/2006
Last updated
07/09/2007
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