Provider Demographics
NPI:1609235357
Name:WILLIS, CHARITY BAKER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:BAKER
Last Name:WILLIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:MAIRE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 BRIGHTMORE WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-6737
Mailing Address - Country:US
Mailing Address - Phone:727-483-4599
Mailing Address - Fax:352-735-3151
Practice Address - Street 1:1155 PERIMETER CTR FL 11
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5463
Practice Address - Country:US
Practice Address - Phone:404-383-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9342970163W00000X
FLRN934970363L00000X
FLARNP9342970363LF0000X
GA294190363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609235357OtherNPI