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NPI Code Detail

MEDICARE: AMBER D WILLIS MD

MEDICARE: AMBER D WILLIS MD
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
1207P00000XEmergency Medicine PhysicianML002812PA
2207Q00000XFamily Medicine Physician40153SC

General Provider Information

NPI Number : 1649443607
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER D WILLIS MD
Provider Business Mailing Address
First Line : PO BOX 751649
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1649
Country : US
Telephone Number : 843-789-1620
Fax Number : 843-724-2440
Provider Business Practice Location Address
First Line : 1114 N MAIN ST
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-7326
Country : US
Telephone Number : 843-212-8070
Fax Number : 843-212-8071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2008
Last Update Date : 01/23/2017

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Directions to “ AMBER D WILLIS MD” Practice Location

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