MEDICARE: CARL ROGASTON WILLIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	037952	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4090607	OTHER	TN	BCBS OF TN IND PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154376259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL ROGASTON WILLIS M.D.

Provider Business Mailing Address
First Line	:	2004 HAYES ST STE 800
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2659
Country	:	US
Telephone Number	:	615-329-0570
Fax Number	:	615-329-0579

Provider Business Practice Location Address
First Line	:	322 22ND AVE N STE 400
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1870
Country	:	US
Telephone Number	:	615-320-5090
Fax Number	:	615-320-1225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	09/17/2025

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