BETHANY WILEY LILL (NPI# 1316298953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316298953 |
| Entity Type | Individual |
| Full Name | BETHANY WILEY LILL |
| Practice Address |
720 Transit Ave Suite 202 Canton GA 30114-2540 |
| Mailing Address |
300 Tower Rd Ne Suite 200 Marietta GA 30060-9404 |
| Practice Telephone | 7704275717 |
| Practice Fax Number | 7705146744 |
| Mailing Telephone | 7704275717 |
| Mailing Fax Number | 7705146744 |
| Enumeration Date | 2012-09-22 |
| Last Update Date | 2014-08-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
006629 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | MEDICARE PTAN | 20I2973206 | 01 |
| Street Address |
720 TRANSIT AVE SUITE 202 |
| City | CANTON |
| State | GA |
| Zip Code | 30114-2540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548219330 | Charles R Cooley | Family Medicine | 720 Transit Ave, Suite 101, Canton, GA 30114-2571 | 2006-05-09 |
| 1942761150 | Robert Breingan | Physical Therapist | 720 Transit Ave, Canton, GA 30114-2540 | 2019-03-29 |
| 1699104554 | Valerie Ciesla | Physical Therapist | 720 Transit Ave, Suite 202, Canton, GA 30114-2540 | 2013-11-01 |
| 1427333293 | Wellstar Cardiovascular Medicine, LLC | Internal Medicine | 720 Transit Ave, Suite 102, Canton, GA 30114-2540 | 2011-10-12 |
| 1184864258 | Kennestone Heart Physicians Group, PC | Internal Medicine | 720 Transit Ave, Building 100, Suite 102, Canton, GA 30114-2540 | 2009-03-02 |
| 1740448372 | Physicians Family Medicine of Canton, LLC | Clinic/Center | 720 Transit Ave, Ste 101, Canton, GA 30114-2571 | 2008-05-30 |
| 1053453852 | Pinnacle Orthopaedics & Sports Medicine Specialists LLC | Orthopaedic Surgery | 720 Transit Ave, Suite 202, Canton, GA 30114 | 2007-02-12 |
| 1306921226 | Physiotherapy Associates Inc | Clinic/Center | 720 Transit Ave, Suite 102, Canton, GA 30114-2571 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619516093 | Wickshire Canton Opco LLC | Assisted Living Facility | 125 Riverstone Terrace, Canton, GA 30114 | 2020-01-02 |
| 1154803583 | Alixandra Nicole Flournoy | Physical Therapist | 131 Holly Street, Canton, GA 30114 | 2018-09-01 |
| 1588157341 | Provident Group - Canton Cove Properties LLC | Alzheimer Center (Dementia Center) | 1100 Reinhardt College Parkway, Canton, GA 30114 | 2018-06-07 |
| 1003233107 | Heartland Dental Care of Georgia | Dentist | 3237 Sixes Rd, Canton, GA 30114 | 2014-03-26 |
| 1730510959 | Joseph Optical | Eyewear Supplier (Equipment, not the service) | 1455 Riverstone Pkwy Suite 110, Canton, GA 30114 | 2013-12-13 |
| 1629313036 | Ramona Morton Rasmussen | Occupational Therapist | 200 Riverstone Drive, Suite B, Canton, GA 30114 | 2012-12-11 |
| 1902154875 | Yong Qiao Luo | Acupuncturist | 200 Oakside Lane, Suite D, Canton, GA 30114 | 2012-08-26 |
| 1215294350 | Christina Lynn Hernandez | Pediatrics | 1558 Riverstone Pkwy Ste 100, Canton, GA 30114 | 2012-04-13 |
| 1558638981 | Stephen E Byrd | Counselor | 191 Lamar Haley Pkwy., Canton, GA 30114 | 2011-11-30 |
| 1073807855 | Sheri Sullins Buckley | Nurse Practitioner | 120 Oakside Ct Ste H, Canton, GA 30114 | 2011-06-08 |
| Find all providers in zip 30114 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740599182 | Terri Rybak | Physician Assistant | 3493 Lower Burris Rd, Canton, GA 30114-4755 | 2010-10-04 |
| 1427297811 | Darrick Lamont Clark | Physician Assistant | 111 Holly Mill Village Dr, Canton, GA 30114-7175 | 2009-02-09 |
| 1083834691 | Debra H Bureau | Physician Assistant | 1460 Ledgewood Dr, Canton, MI 48188-1135 | 2007-04-26 |
| 1760528434 | Heather J Hall | Physician Assistant | 470 Northside Cherokee Blvd Ste 490, Canton, GA 30115 | 2007-01-30 |
| 1407371768 | Prologue Surgical Assisting, LLC | Physician Assistant | 3493 Lower Burris Rd, Canton, GA 30114 | 2017-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336748409 | Jesse Aaron Denson | Physician Assistant | 2046 Point Grey Ct Nw, Kennesaw, GA 30152-8276 | 2020-10-20 |
| 1568074227 | James D Craig | Physician Assistant | 3210 New College Way, Cumming, GA 30041-2896 | 2020-08-23 |
| 1982223244 | Keith Hawkins | Physician Assistant | 8498 Glenview St, Douglasville, GA 30134-5639 | 2020-04-15 |
| 1639704307 | Spectrum Surgical LLC | Physician Assistant | 3142 Highway 278 Nw # 135, Covington, GA 30014-2304 | 2020-03-03 |
| 1255962205 | Songthu Nguyen | Physician Assistant | 6119 Foxcroft Ct, Morrow, GA 30260-1069 | 2020-01-29 |
| 1265071229 | Stellar Surgical Assisting | Physician Assistant | 3446 Winder Hwy Ste M-322, Flowery Branch, GA 30542-3007 | 2019-12-22 |
| 1194363366 | Clara A Matthews | Physician Assistant | 1930 Windsor Creek Drive Sw, Conyers, GA 30094 | 2019-12-18 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1710528401 | Hannah Ingrid Boomgarden | Physician Assistant | 1467 Harper Street Hb 5040, Augusta, GA 30912-5775 | 2019-10-03 |
| 1891257028 | Symmetry Surgical Billing LLC | Physician Assistant | 5135 Mirror Lake Dr, Cumming, GA 30028-7216 | 2019-04-05 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BETHANY WILEY LILL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.