MEDICARE: DR. HOWARD WILLIS M.D.

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	302F00000X	Exclusive Provider Organization	030693	GA
2	207R00000X	Internal Medicine Physician	030693	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	673454	OTHER	GA	BCBSGA

General Provider Information

NPI Number	:	1619900537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD WILLIS M.D.

Provider Business Mailing Address
First Line	:	2300 MANCHESTER EXPY STE 2001A
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6802
Country	:	US
Telephone Number	:	706-320-3126
Fax Number	:	706-320-3054

Provider Business Practice Location Address
First Line	:	1005 TALBOTTON RD
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8757
Country	:	US
Telephone Number	:	706-321-3901
Fax Number	:	706-321-3904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/07/2024

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Directions to “ DR. HOWARD WILLIS M.D.” Practice Location

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