Provider Demographics
NPI:1003475583
Name:MCCURRY, WILLIE S
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:S
Last Name:MCCURRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1248
Mailing Address - Country:US
Mailing Address - Phone:216-609-7874
Mailing Address - Fax:
Practice Address - Street 1:1927 SUNSET DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1248
Practice Address - Country:US
Practice Address - Phone:216-609-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP834607172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver