Lill, Bethany Wiley
Lill, Bethany Wiley is an individual health care provider with primary practice located at 720 Transit Ave Suite 202, Canton GA 30114-2540. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Lill, Bethany Wiley can be contacted via phone (770) 427-5717.Contact Information
Primary practice address
720 Transit Ave Suite 202
Canton GA 30114-2540
Phone: (770) 427-5717
Fax: (770) 514-6744
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | ||
Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | 006629 | Georgia |
Profile Details
NPI number | 1316298953 |
---|---|
LBN Legal business name | Lill, Bethany Wiley |
Credentials | |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Sep 22nd, 2012 |
Last updated | Aug 27th, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1316298953 | NPPES |
Georgia | Other | 20I2973206 | MEDICARE PTAN |
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