Provider Demographics
NPI:1700828977
Name:WILLIS, MELVIN JAMES (PA)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:JAMES
Last Name:WILLIS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:142 DOVE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4780
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3574
Practice Address - Street 1:JAMES H QUILLEN/VA MEDICAL CENTER
Practice Address - Street 2:CONER OF SIDNEY & LAMONT
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3574
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TNTN 0250363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical