Individual provider Active NPI

Leah Maria Wills, PA-C

  • Physician Assistant
  • Hattiesburg, MS
National Provider Identifier
1639405749
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00807 Issued in MS
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 268-5888
Fax
(601) 261-3587
NPI assigned
Oct 23, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002991 OH
Physician Assistant 363A00000X PA00807 MS Primary
Physician Assistant 363A00000X 0010-06814 NC
Physician Assistant 363A00000X 7385 GA

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

Other identifiers 1

IdentifierTypeStateIssuer
1639405749MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250924001014 MS Practitioner - Physician Assistant 2860531365 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

201 A Bay Ave
Richton, MS 39476-9671
Phone (601) 583-1559

415 S 28TH Ave
Hattiesburg, MS 39401-7246

415 S 28TH Ave 3Rd Floor
Ambulatory Cardiovascular Center of Mississ
Hattiesburg, MS 39401-7246
Phone (601) 268-1734

415 S 28TH Ave FL
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

4209 Lincoln Rd
Hattiesburg, MS 39402-3065
Phone (601) 264-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002991OHMDAthletic Trainer
7385GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic, PA CurrentSince Sep 10, 2025 Accepting new patients
Hattiesburg Clinic PA CurrentSince Sep 10, 2025 Accepting new patients
Georgia Primary Care Partners, LLC Current Accepting new patients
Hattiesburg Clinic, PA Past Accepting new patients
State of Mississippi - University of Mississippi Medical Center Past Accepting new patients

Locations

60 Exchange St
Ste B7
Richmond Hill, GA 31324
Phone (912) 756-2273

415 S 28th Ave
#1J
Hattiesburg, MS 39401

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

415 S 28th Ave
Ste 1J
Hattiesburg, MS 39401

Interoperability endpoints

  • Direct secure messaging: lwills152819@directpatientrecord.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1639405749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-264-6000",
            "fax_number": "601-261-3587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-268-5888",
            "fax_number": "601-261-3587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLS",
        "first_name": "LEAH",
        "middle_name": "MARIA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-10-23",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "002991",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MS",
            "license": "PA00807",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06814",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "7385",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639405749",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.