Healthcare Provider Details

I. General information

NPI: 1679932115
Provider Name (Legal Business Name): CORNELIA J WILLIS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

6510-A S ACADEMY BLVD
COLORADO SPRINGS CO
80906-8691
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2273
  • Fax:
Mailing address:
  • Phone: 719-362-5152
  • Fax: 719-888-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number30523
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30523
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0070727
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: