Individual
WILLIS MCCOY PRIVOTT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1610 OPELIKA RD, PHENIX CITY, AL 36867-3634
(334) 291-0221
(334) 291-1939
Mailing address
1610 OPELIKA RD, PHENIX CITY, AL 36867-3634
(334) 291-0221
(334) 291-1939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
00017192
AL
208000000X
Pediatrics Physician
038916
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000639416C
—
GA
05
—
009986080
—
AL
Enumeration date
11/10/2005
Last updated
10/03/2012
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