Willis, Jeffrey Todd

Willis, Jeffrey Todd is an sole proprietor health care provider with primary practice located at 1003 Holland Ave Ste 104 , Philadelphia MS 39350-2180. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Willis, Jeffrey Todd can be contacted via phone (601) 656-0010.

Contact Information

Primary practice address
1003 Holland Ave Ste 104 Philadelphia MS 39350-2180
Phone: (601) 656-0010
Fax: (601) 656-0313
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 12556 Mississippi

Profile Details

NPI number 1639100340
LBN Legal business name Willis, Jeffrey Todd
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 5th, 2006
Last updated Nov 16th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639100340 NPPES
Mississippi MEDICAID 0114279

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