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General NPI Number Information
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NPI Number | 1083228597
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Entity Type | Organization
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Legal Business Name | DR CELESTE REESE WILLIS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 401 TUSCALOOSA AVE SW STE 210
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City | BIRMINGHAM
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State | AL
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Zip | 35211-1486
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Country | US
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Telephone | 205-291-8842
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Fax | 205-235-9592
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Provider Business Mailing Address
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Address Line | 944 NARROWS POINT DR
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City | BIRMINGHAM
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State | AL
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Zip | 35242-8672
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Country | US
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Telephone | 205-747-9340
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Fax | 205-235-9592
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Authorized Official
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Title or Position | CEO
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Name | DR. CELESTE REESE WILLIS
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Credential | MD
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Telephone | 205-291-8842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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