Healthcare Provider Details

I. General information

NPI: 1083228597
Provider Name (Legal Business Name): DR CELESTE REESE WILLIS MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 TUSCALOOSA AVE SW STE 210
BIRMINGHAM AL
35211-1486
US

IV. Provider business mailing address

944 NARROWS POINT DR
BIRMINGHAM AL
35242-8672
US

V. Phone/Fax

Practice location:
  • Phone: 205-291-8842
  • Fax: 205-235-9592
Mailing address:
  • Phone: 205-747-9340
  • Fax: 205-235-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CELESTE REESE WILLIS
Title or Position: CEO
Credential: MD
Phone: 205-291-8842