Provider Demographics
NPI:1538169115
Name:SNYDER, WILLARD ALEXANDER JR (MD)
Entity type:Individual
Prefix:
First Name:WILLARD
Middle Name:ALEXANDER
Last Name:SNYDER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 STARLING ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4215
Mailing Address - Country:US
Mailing Address - Phone:912-265-9900
Mailing Address - Fax:912-265-2074
Practice Address - Street 1:2314 STARLING ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4215
Practice Address - Country:US
Practice Address - Phone:912-265-9900
Practice Address - Fax:912-265-2074
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00420164DMedicaid
GA85002553GMedicaid
E80551Medicare UPIN
GA85002553GMedicaid