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Individual
WILLIS MCCOY PRIVOTT JR.
Active
Individual
WILLIS MCCOY PRIVOTT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
00017192
AL
208000000X
Pediatrics Physician
038916
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000639416C
—
GA
05
—
009986080
—
AL
Enumeration date
11/10/2005
Last updated
10/03/2012
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