Healthcare Provider Details

I. General information

NPI: 1427143130
Provider Name (Legal Business Name): DAVID V WILLBANKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 W MORRIS BLVD
MORRISTOWN TN
37813-2837
US

IV. Provider business mailing address

1817 W MORRIS BLVD
MORRISTOWN TN
37813-2837
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-3904
  • Fax: 423-581-6120
Mailing address:
  • Phone: 423-581-3904
  • Fax: 423-581-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6010
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: