Individual
DEBORAH WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5261 CARROLLTON PIKE STE B, WOODLAWN, VA 24381-3030
(276) 238-8876
(276) 238-8886
Mailing address
5261 CARROLLTON PIKE STE B, WOODLAWN, VA 24381-3030
(276) 238-8876
(276) 238-8886
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19080
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01955299
—
MS
01
—
26-1083931
TAX ID
—
01
—
C10361
GROUP ORGANIZATION PTAN
—
01
—
DN2980
GROUP PTAN
—
Enumeration date
03/02/2006
Last updated
09/29/2014
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