Individual
DR. CHARLES KEITH WILLIS
Active
Individual
DR. CHARLES KEITH WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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