Provider Demographics
NPI:1083228597
Name:DR CELESTE REESE WILLIS MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:DR CELESTE REESE WILLIS MEDICAL GROUP, LLC
Other - Org Name:DCRW MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:REESE
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-291-8842
Mailing Address - Street 1:944 NARROWS POINT DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8672
Mailing Address - Country:US
Mailing Address - Phone:205-747-9340
Mailing Address - Fax:205-235-9592
Practice Address - Street 1:401 TUSCALOOSA AVE SW STE 210
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1486
Practice Address - Country:US
Practice Address - Phone:205-291-8842
Practice Address - Fax:205-235-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty