Justin Dewillers, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

73556 Issued in GA

Practice address

705 Dixie St
Carrollton, GA 30117-3818

Phone

(770) 836-9560

NPI assigned

May 13, 2010

Last updated

Jan 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Albany Medical College of Union University, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carrollton Emergency Physicians PCGroup PAC ID 7416860010, 34 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tanner Medical Center Villa Rica Hospital, Villa Rica, GA, CCN 110015
• Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Carrollton Emergency Physicians, PC

  • Emergency Medicine Physician
  • Carrollton, GA
  • NPI 1790724672
  Medicare reassignment Care Compare group NPD

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

• Tanner Medical Center, Inc

  dba Tanner Health System

  • General Acute Care Hospital
  • Carrollton, GA
  • NPI 1801883780
  Care Compare affiliation
• TMC/Villa Rica Hospital, Inc

  dba Tanner Health System

  • General Acute Care Hospital
  • Villa Rica, GA
  • NPI 1851388748
  Care Compare affiliation

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

{
    "created_epoch": "1273708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1932427010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "770-836-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "770-836-9560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWILLERS",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-13",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "73556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Denney, MD
• Jennifer L Densmore, NP
• Dental Center of Carrollton
• Dermatology Specialists of W Ga (Newnan Dermatology)
• Dana E Dewberry, RNFA
• Anil A Dhople, M.D.
• Andrea Leigh Dinarte
• Jeffrey Dishman, CRNA
• Dixie Street Dental LLC (Dental Center of Carrollton)
• Angela Dixon, LCSW

• Emergency Medicine Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Emergency Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.