Individual
DEIDRA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A- GNP
Contact information
Practice address
6439 GARNERS FERRY RD, COLUMBIA, SC 29209-1638
(803) 776-4000
Mailing address
160 KATRINA CT, LEXINGTON, SC 29073-6924
(803) 413-8700
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
20835
SC
Other
Enumeration date
04/29/2017
Last updated
04/29/2017
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