DR. JEFFERY TODD WILLIS (NPI# 1639100340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639100340 |
| Entity Type | Individual |
| Full Name | DR. JEFFERY TODD WILLIS |
| Credential | MD |
| Practice Address |
1003 Holland Ave Ste 104 Philadelphia MS 39350-2180 |
| Practice Telephone | 6016560010 |
| Practice Fax Number | 6016560313 |
| Mailing Telephone | (601) 656-0010 |
| Mailing Fax Number | 6016560313 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2017-09-06 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 12556 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0114279 | 05 |
| Street Address |
1003 HOLLAND AVE STE 104 |
| City | PHILADELPHIA |
| State | MS |
| Zip Code | 39350-2180 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548817133 | Airpark Family Dentistry | Dentist | 1060 Holland Avenue, Philadelphia, MS 39350 | 2019-08-20 |
| 1396303962 | Medical Foundation Inc | Obstetrics & Gynecology | Rush Medical Group / Philadelphia, 1106 Central Drive, Ste 3, Philadelphia, MS 39350 | 2019-05-30 |
| 1144759580 | Mapp Home Care Services | In Home Supportive Care | 41 Eastover Dr, Philadelphia, MS 39350 | 2017-06-08 |
| 1710411707 | Rcg Mississippi, Inc. | Clinic/Center | 1100 Central Drive, Philadelphia, MS 39350 | 2017-04-17 |
| 1114339405 | Bernard Oneal | Adult Companion | 10090 Rd 0022, None, Philadelphia, MS 39350 | 2014-05-21 |
| 1417213323 | Region Ten Commision On Mental Health | Clinic/Center | 1011 Posey Avenue, Philadelphia, MS 39350 | 2012-04-04 |
| 1851427132 | Performance Therapy LLC | Physical Therapist | Performance Therapy, LLC, 921 W Beacon Street, Philadelphia, MS 39350 | 2007-02-23 |
| 1922161900 | Ernest Barton Cross | Audiologist | 1120 East Main Street, Suite 4, Philadelphia, MS 39350 | 2006-12-19 |
| 1649348129 | Augustus P Soriano | Family Medicine | 517 Center Avenue, Philadelphia, MS 39350 | 2006-12-01 |
| 1982777983 | Bill G Molpus | Dentist | 247 Byrd Ave, Philadelphia, MS 39350 | 2006-11-16 |
| Find all providers in zip 39350 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1831755735 | Good Hope Health Center Corp | General Practice | 7712 Buist Ave, Philadelphia, PA 19153-1705 | 2019-05-15 |
| 1366008260 | Ltc Treatment Center Inc | General Practice | 7712 Buist Ave Apt B, Philadelphia, PA 19153-1705 | 2019-05-15 |
| 1972072288 | Paula Alejandra Pino Pommer | General Practice | 3551 North Broad St., Philadelphia, PA 19140-4160 | 2018-11-15 |
| 1689183121 | Gem Wound Specialists, LLC | General Practice | 250 N Columbus Blvd Apt 707, Philadelphia, PA 19106-1458 | 2017-09-27 |
| 1023556875 | Bralow Medical Group | General Practice | 834 South St., Philadelphia, PA 19147 | 2017-02-01 |
| 1790135358 | Jeffrey Anthony Gazzara Jr. | General Practice | 621, 1515 Market Street, Suite 1200, Philadelphia, PA 19102-1921 | 2016-06-14 |
| 1053788240 | J. Todd Willis, Md Clinic | General Practice | 1003 Holland Avenue, Suite 104, Philadelphia, MS 39350-2180 | 2015-08-24 |
| 1225411655 | Brian Michael Lauer | General Practice | 609 E Passyunk Ave Apt 2, Philadelphia, PA 19147-1530 | 2015-07-02 |
| 1003294588 | Health Hero Pa LLC | General Practice | 217 Dickinson St, Philadelphia, PA 19147-6003 | 2015-05-15 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 39350 |
Please comment or provide details below to improve the information on DR. JEFFERY TODD WILLIS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.