Individual
BETHANY WILEY LILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
006629
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20I2973206
MEDICARE PTAN
GA
Enumeration date
09/22/2012
Last updated
08/27/2014
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