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General NPI Number Information
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NPI Number | 1558616532
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Entity Type | Organization
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Legal Business Name | WILLIS FAMILY MEDICAL CENTER, P.C.
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 3441 LEBANON PIKE STE 101
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City | HERMITAGE
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State | TN
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Zip | 37076-2000
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Country | US
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Telephone | 615-316-5662
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Fax | 615-316-5666
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Provider Business Mailing Address
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Address Line | 3441 LEBANON PIKE STE 101
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City | HERMITAGE
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State | TN
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Zip | 37076-2000
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Country | US
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Telephone | 615-316-5662
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Fax | 615-316-5666
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA BELL-WILLIS
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Credential | MD
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Telephone | 615-316-5662
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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 | MD0000030394
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License Number State | TN
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