Provider Demographics
NPI:1962794172
Name:WILLS, BRIAN M (PA)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:WILLS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:776 WEATHERLY DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8941
Practice Address - Country:US
Practice Address - Phone:615-941-8501
Practice Address - Fax:615-941-8102
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2021-07-20
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Provider Licenses
StateLicense IDTaxonomies
TN4351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant