Individual
DR. JOHN HARTER WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
(336) 659-2446
Mailing address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
(336) 659-2446
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01088365A
IN
207Y00000X
Otolaryngology Physician
Primary
2015-00476
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BCBSNC
NC
01
—
PENDING
UNITED HEALTHCARE
—
05
—
PENDING
—
NC
Enumeration date
04/05/2010
Last updated
06/19/2023
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