MEDICARE: WILLIS FAMILY MEDICAL CENTER, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD0000030394	TN

General Provider Information

NPI Number	:	1558616532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIS FAMILY MEDICAL CENTER, P.C.

Provider Business Mailing Address
First Line	:	3441 LEBANON PIKE STE 101
Second Line	:
City	:	HERMITAGE
State	:	TN
Zip	:	37076-2000
Country	:	US
Telephone Number	:	615-316-5662
Fax Number	:	615-316-5666

Provider Business Practice Location Address
First Line	:	3441 LEBANON PIKE STE 101
Second Line	:
City	:	HERMITAGE
State	:	TN
Zip	:	37076-2000
Country	:	US
Telephone Number	:	615-316-5662
Fax Number	:	615-316-5666

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA BELL-WILLIS
Credential	:	MD
Telephone Number	:	615-316-5662

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	07/17/2012

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