Willis, Mark L

Willis, Mark L is an individual health care provider with primary practice located at 208 Haven Dr Southeast Pain Mgmt Center, Dothan AL 36301-2909. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Interventional Pain Medicine. Allopathic & Osteopathic Physicians / Interventional Pain Medicine is his primary health care specialty. Willis, Mark L can be contacted via phone (334) 793-8196.

Contact Information

Primary practice address
208 Haven Dr Southeast Pain Mgmt Center Dothan AL 36301-2909
Phone: (334) 793-8196
Fax: (334) 699-4757
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 00025952 Alabama
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 00025952 Alabama
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 00025952 Alabama

Profile Details

NPI number 1740269612
LBN Legal business name Willis, Mark L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 10th, 2006
Last updated May 11th, 2017 - about 7 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 1740269612 NPPES
Georgia Other 622443016A MEDICAID
Georgia Other 51521334 MEDICAID

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