Willis, Samuel M

Willis, Samuel M is an individual health care provider with primary practice located at 2739 Laurel St 1-A, Columbia SC 29204-2028. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Willis, Samuel M can be contacted via phone (803) 799-4800.

Contact Information

Primary practice address
2739 Laurel St 1-A Columbia SC 29204-2028
Phone: (803) 799-4800
Fax: (803) 256-0397
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 12083 South Carolina

Profile Details

NPI number 1770586588
LBN Legal business name Willis, Samuel M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Oct 16th, 2012 - about 12 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 1770586588 NPPES
South Carolina MEDICAID 120835
South Carolina Other P01077735

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