Individual
MR. JERAMY C. WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
KCSA
Contact information
Practice address
1945 SCOTTSVILLE RD, B2 PMB 397, BOWLING GREEN, KY 42104-3376
(270) 781-4828
(270) 781-4828
Mailing address
1945 SCOTTSVILLE RD. B2 PMB 397, BOWLING GREEN, KY 42104
(270) 781-4828
(270) 781-4828
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA164
KY
Other
Enumeration date
12/17/2007
Last updated
12/17/2007
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