Individual
MARION A WILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 OLD GREENVILLE HWY, CLEMSON, SC 29631
(864) 653-8964
(846) 653-8963
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
049597
GA
208000000X
Pediatrics Physician
Primary
52223
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000919256A
—
GA
05
—
000919256D
—
GA
05
—
000919256E
—
GA
01
—
117546
PEACHSTATE MEDICAID
GA
05
—
300035718A
—
GA
01
—
374160
WELLCARE MEDICAID
GA
05
—
522232
—
SC
01
—
830853
BCBS GEORGIA
GA
Enumeration date
07/14/2006
Last updated
05/07/2021
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