Active NPI
Connor Dale Willyard, PHARM D
- Pharmacist
- Reidsville, GA
National Provider Identifier
1295479301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH029677
- Practice address
- 214 S Main St
Reidsville, GA 30453-4602 - Phone
- (912) 557-4701
- NPI assigned
- Apr 25, 2022
- Last updated
- Apr 25, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH029677 | GA | Primary |
Addresses
Primary practice location
214 S Main St
Reidsville, GA 30453-4602
Mailing address
1910 Mount Vernon Alston Rd
Ailey, GA 30410-2446
Phone (912) 253-2088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH029677 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-Care Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1650844800000",
"number": "1295479301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1910 MOUNT VERNON ALSTON RD",
"city": "AILEY",
"state": "GA",
"postal_code": "304102446",
"telephone_number": "912-253-2088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 S MAIN ST",
"city": "REIDSVILLE",
"state": "GA",
"postal_code": "304534602",
"telephone_number": "912-557-4701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLYARD",
"first_name": "CONNOR",
"middle_name": "DALE",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-25",
"last_updated": "2022-04-25",
"certification_date": "2022-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH029677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reidsville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.