Provider Demographics
NPI:1376572990
Name:WILLIS, WILLIAM N (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:N
Last Name:WILLIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 DALLAS ST NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-2704
Mailing Address - Country:US
Mailing Address - Phone:770-429-7070
Mailing Address - Fax:770-425-9020
Practice Address - Street 1:2829 DALLAS ST NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-2704
Practice Address - Country:US
Practice Address - Phone:770-429-7070
Practice Address - Fax:770-425-9020
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor