Individual
DR. JEFFREY TODD WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1003 HOLLAND AVE STE 104, PHILADELPHIA, MS 39350-2180
(601) 656-0010
(601) 656-0313
Mailing address
1003 HOLLAND AVE STE 104, PHILADELPHIA, MS 39350-2180
(601) 656-0010
(601) 656-0313
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
12556
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0114279
—
MS
Enumeration date
07/05/2006
Last updated
11/16/2020
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