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General NPI Number Information
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NPI Number | 1033179478
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Entity Type | Individual
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Provider Name | WILLIAM ALLEN WILLIS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 2850 VILLAGE DR SUITE 103
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3864
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Country | US
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Telephone | 910-223-9801
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Fax | 910-223-9819
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Provider Business Mailing Address
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Address Line | PO BOX 42005
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City | FAYETTEVILLE
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State | NC
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Zip | 28309-2005
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Country | US
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Telephone | 910-223-9801
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Fax | 910-223-9819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 22449
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License Number State | NC
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