Individual
SAMUEL M WILLIS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2739 LAUREL ST, 1-A, COLUMBIA, SC 29204-2028
(803) 799-4800
(803) 256-0397
Mailing address
PO BOX 402145, ATLANTA, GA 30384-2145
(803) 296-3502
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
12083
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120835
—
SC
01
—
P01077735
MEDICARE RAILROAD
SC
Enumeration date
05/24/2005
Last updated
10/16/2012
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