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General NPI Number Information
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NPI Number | 1679622062
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Entity Type | Individual
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Provider Name | DAVID P. WILLETT MD,PA
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 5-B EAST OWENS LANE
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City | MAULDIN
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State | SC
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Zip | 29662-2635
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Country | US
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Telephone | 864-288-4765
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1004
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City | MAULDIN
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State | SC
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Zip | 29662-1004
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Country | US
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Telephone | 864-288-4765
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Fax |
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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 | 11946
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License Number State | SC
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