Organization
MOULTRIE PEDIATRICS, LLC
Active
Other names
Children's Medical Group of SW GA
Organization subpart
No
Provider details
NPI number
Authorized official
MARION A WILLS M.D. (OWNER)
(229) 985-1293
Entity
Organization
Contact information
Practice address
1 SWEET BAY CT, SUITE A, MOULTRIE, GA 31768-6756
(229) 985-1293
(229) 891-2123
Mailing address
PO BOX 129, MOULTRIE, GA 31776-0129
(229) 985-1293
(229) 891-2123
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300035718A
—
GA
01
—
3083
PEACHSTATE
GA
01
—
396284
WELLCARE
GA
Enumeration date
08/27/2007
Last updated
10/27/2011
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