Healthcare Provider Details

I. General information

NPI: 1730767377
Provider Name (Legal Business Name): JOHN ALAN WILLIS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N MEDICAL DR
CHAPEL HILL NC
27599-5022
US

IV. Provider business mailing address

160 N MEDICAL DR
CHAPEL HILL NC
27599-5022
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-4676
  • Fax:
Mailing address:
  • Phone: 919-966-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number304574
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: