Individual
CORNELIUS WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 MORRIS ST APT 18, BAYTOWN, TX 77520-3553
(346) 710-5088
Mailing address
1501 MORRIS ST APT 18, BAYTOWN, TX 77520-3553
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-3063556
—
TX
Enumeration date
10/13/2021
Last updated
10/13/2021
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