Organization
MEDIPRACTIC LLC
Active
Other names
Medipractic Pain Management
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM E WILLIS DC CDE1 DAAPM (SEC)
(770) 496-0326
Entity
Organization
Contact information
Practice address
3955 HARRISON RD, STE. 400, LOGANVILLE, GA 30052-8501
(770) 496-0326
(770) 492-9599
Mailing address
3955 HARRISON RD, STE. 400, LOGANVILLE, GA 30052-8501
(770) 496-0326
(770) 492-9599
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
—
—
Other
Enumeration date
12/06/2006
Last updated
12/21/2012
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