Individual
CHARLES ADAM WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
6419 BRISTOL HWY, PINEY FLATS, TN 37686-5208
(423) 538-5202
(423) 538-8208
Mailing address
6419 BRISTOL HWY, PINEY FLATS, TN 37686-5208
(423) 538-5202
(423) 538-8208
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0000177156
TN
363LF0000X
Family Nurse Practitioner
Primary
18377
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q003839
—
TN
Enumeration date
02/05/2014
Last updated
02/28/2017
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