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General NPI Number Information
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NPI Number | 1104893809
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Entity Type | Individual
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Provider Name | CELESTE REESE WILLIS MD
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Gender | Female
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 09/26/2024
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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 | 205-291-8842
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Fax | 205-235-9592
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26026
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License Number State | AL
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