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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316298953 NPPES
Georgia Other 20I2973206 MEDICARE PTAN

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