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Individual

DR. CHARLES KEITH WILLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
912 THIRD STREET, SUITE 101, GREENSBORO, NC 27405-6967
(336) 273-2511
(336) 370-0287
Mailing address
PO BOX 29568, GREENSBORO, NC 27429-9568
(336) 273-2511
(336) 370-0287

Taxonomy

Speciality
Code
Description
License number
State
2084D0003X
Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
33768
NC
2084N0400X
Neurology Physician
Primary
33768
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
130015016
PALMETTO GBA RR MEDICARE
NC
Enumeration date
04/26/2006
Last updated
09/17/2021
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