Individual
ALYSSA L.M. WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
450 NORTHSIDE CHEROKEE BLVD, CANTON, GA 30115-8015
(770) 224-1000
Mailing address
1654 FAIR OAK WAY, MABLETON, GA 30126-5754
(228) 238-1211
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
RN224983
GA
363LP0200X
Pediatric Nurse Practitioner
Primary
RN224983
GA
Other
Enumeration date
06/10/2021
Last updated
01/29/2026
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