DR. JOHN CHURCHILL WILLIS III (NPI# 1922355155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922355155 |
| Entity Type | Individual |
| Full Name | DR. JOHN CHURCHILL WILLIS III |
| Credential | M.D. |
| Practice Address |
823 Weeden Island Dr Niceville FL 32578-3724 |
| Practice Telephone | 8506787167 |
| Mailing Telephone | 8506787167 |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | ME13866 | FL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700021425 | John Glen Willis | Counselor | 1030 Johnson Rd Ste 286, Golden, CO 80401-6003 | 2008-12-09 |
| 1215093018 | John M Willis | Dentist | 6 Fundy Rd, Falmouth, ME 04105-1705 | 2006-12-28 |
| 1205891207 | John M Willis | Internal Medicine | 2800 E Broad St Ste 512, Mansfield, TX 76063-6417 | 2006-04-20 |
| 1356310577 | John Curtis Willis | Chiropractor | 305 Allegheny St, Richlands, VA 24641 | 2006-03-17 |
| 1548253172 | John A Willis | Orthopaedic Surgery | 130 N Street Ext, Hyannis, MA 02601-3825 | 2005-08-30 |
| 1063952190 | John Willis | Counselor | 22 Old Canal Dr, Lowell, MA 01851-2730 | 2017-03-08 |
| 1205211208 | John Macphee Willis | Dentist | 160 E. Erie Ave, St. Christopher's Hospital for Children, Attn: Dental, Philadelphia, PA 19134 | 2015-07-21 |
| 1619393493 | John Willis | Pharmacist | 1401 Minnesota Ave, Libby, MT 59923-2309 | 2014-03-17 |
| 1356763791 | John Willis | Pharmacist | 6131 E Southern Ave, Mesa, AZ 85206-3732 | 2014-01-18 |
| 1275831703 | John Evan Willis | Nurse Practitioner | 4810 Whitesport Cir Sw, Suite 110, Huntsville, AL 35801-7419 | 2011-03-08 |
| Street Address |
823 WEEDEN ISLAND DR |
| City | NICEVILLE |
| State | FL |
| Zip Code | 32578-3724 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376028563 | Southern Breeze Healthcare | Family Medicine | 4556 E Hwy 20, Suite 105, Niceville, FL 32578 | 2018-10-03 |
| 1497252860 | Molly Marie Everitt | Physician Assistant | 2190 Fl-85 N, Niceville, FL 32578 | 2018-04-11 |
| 1972009314 | Alexis Aust | Student in an Organized Health Care Education/Training Program | 104 Arrowhead Way, Niceville, FL 32578 | 2018-04-04 |
| 1518488949 | Michelle Sasala | Nurse Practitioner | 4550 E Highway 20, Niceville, FL 32578 | 2017-07-06 |
| 1003336199 | Comfortable Care Denta Health Professionals, Pa | Dentist | 1386 E John Sims Parkway, Niceville, FL 32578 | 2017-06-21 |
| 1306223888 | Emerald Coast Periodontics | Dentist | 719 Bayshore Drive, Niceville, FL 32578 | 2015-05-04 |
| 1538586136 | Pamela Ottesen Dmd LLC | Dentist | 1536 John Sims Pkwy, Niceville, FL 32578 | 2014-03-21 |
| 1417204066 | Mary Jo Stiles | Hearing Instrument Specialist | 4400 Hwy, 20 East, Suite # 211, Niceville, FL 32578 | 2012-08-13 |
| 1093086563 | Pat T. Tidwell Md Pa | Clinic/Center | 4554 Highway 20 East, Niceville, FL 32578 | 2012-01-16 |
| 1952683260 | Gentle Birth Options, LLC | Nurse Practitioner | 296 Bayshore Drive, Niceville, FL 32578 | 2011-09-13 |
| Find all providers in zip 32578 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972691368 | Michael Patrick Roberts | Internal Medicine | 1001 College Blvd W Ste D, Niceville, FL 32578-1049 | 2006-10-11 |
| 1962593574 | Kenneth W Ponder Md Pa | Internal Medicine | 4566 E Highway 20 Ste 103, Niceville, FL 32578-8839 | 2006-09-27 |
| 1275542276 | Roger Riggenbach | Internal Medicine | 101 Hart St, Covenant Hospice, Niceville, FL 32578-1040 | 2006-08-07 |
| 1518905355 | Stephen Joseph Zimmermann | Internal Medicine | 4586 E Highway 20 Ste B, Niceville, FL 32578-9724 | 2006-06-03 |
| 1932177557 | Cynthia Blackwell Bryan | Internal Medicine | 1001 West College Boulevard, Suite G, Niceville, FL 32578-1049 | 2006-03-09 |
| 1477962462 | Flat Top Inpatient Services LLC | Internal Medicine | 2190 Highway 85 N, Niceville, FL 32578-1045 | 2014-08-05 |
| 1114286879 | Michael Adam Weisbruch | Internal Medicine | 1001 College Blvd W, Niceville, FL 32578-1099 | 2012-05-15 |
| 1205107141 | Titan Hospitalist Group LLC | Internal Medicine | 2190 Highway 85 N, Niceville, FL 32578-1045 | 2012-01-24 |
| 1134422389 | Mark E. Schroeder M.d.pa | Internal Medicine | 1005 College Blvd W, Suite C, Niceville, FL 32578-1053 | 2010-12-09 |
| 1730499948 | Cynthia Blackwell Bryan Md Pa | Internal Medicine | 1001 W. College Blvd, Suite G, Niceville, FL 32578 | 2010-10-21 |
| Find all providers in NICEVILLE | ||||
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| 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.