Individual
MR. JULIUS M WILLIS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
707 ANGIER AVE NE, ATLANTA, GA 30308-2925
(404) 213-1898
Mailing address
3711 BENJAMIN E MAYS DR SW, ATLANTA, GA 30331-8600
(404) 213-1898
(866) 384-4420
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037225000
DRIVERS LICENSE
GA
Enumeration date
11/02/2017
Last updated
11/02/2017
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