Provider Demographics
NPI:1023223534
Name:DAVID P WILLETT M.D.
Entity Type:Organization
Organization Name:DAVID P WILLETT M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-288-4765
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-1004
Mailing Address - Country:US
Mailing Address - Phone:864-288-4765
Mailing Address - Fax:
Practice Address - Street 1:5-B EAST OWENS LANE
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2635
Practice Address - Country:US
Practice Address - Phone:864-288-4765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8962Medicare PIN