| W A Willis Md Pa | |
|
2850 Village Dr Suite 103 Fayetteville NC 28304-3869 | |
| (910) 223-9801 | |
| (910) 223-9819 |
| Full Name | W A Willis Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2850 Village Dr, Fayetteville, North Carolina |
| Authorized Official Name and Position | Phyllis L Carter (OFFICE ADMINSTRATOR) |
| Authorized Official Contact | 9103914588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| W A Willis Md Pa Po Box 42005 Fayetteville NC 28309-2005 Ph: (910) 223-9801 | W A Willis Md Pa 2850 Village Dr Suite 103 Fayetteville NC 28304-3869 Ph: (910) 223-9801 |
| NPI Number | 1952662900 |
|---|---|
| Provider Enumeration Date | 06/06/2012 |
| Last Update Date | 06/06/2012 |
| Medicare PECOS PAC ID | 2769646256 |
|---|---|
| Medicare Enrollment ID | O20120613000394 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952662900 | NPI | - | NPPES |
| 8988133 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 22449 (North Carolina) | Primary |
| Provider Name | William A Willis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033179478 PECOS PAC ID: 1456481829 Enrollment ID: I20100610000842 |
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