Provider Demographics
NPI:1417594011
Name:WILLISON, EDWIN JOHN
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:JOHN
Last Name:WILLISON
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 1:740 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1844
Mailing Address - Country:US
Mailing Address - Phone:740-996-7100
Mailing Address - Fax:740-282-5828
Practice Address - Street 1:740 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1844
Practice Address - Country:US
Practice Address - Phone:740-996-7100
Practice Address - Fax:740-282-5828
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator