Willis Medical Ventures, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

WILLIS MEDICAL VENTURES, LLC

Practice address

107 Seagrass Station Rd
Bluffton, SC 29910-9549

Phone

(843) 836-8200

NPI assigned

Mar 1, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Simon Willis, MD

Title

Co-Owner

Phone

(571) 235-3012

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614556800000",
    "number": "1063006195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 LONG CREEK LN",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313248601",
            "telephone_number": "571-235-3012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 SEAGRASS STATION RD",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299109549",
            "telephone_number": "843-836-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS MEDICAL VENTURES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-01",
        "last_updated": "2021-03-01",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "571-235-3012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lena Ashley Williams, BCBA
• Mattie Williams
• Tiffany Williams, FNP-C
• Anthony Williamson, M.D.
• James Derek Williamson
• Nikole M Willman, OTR/L
• Anne Marie Willmann, APN
• Jennifer Wilson
• John Charles Winnestaffer, DC
• Winning Orthodontic Smiles LLC

• Physical Medicine & Rehabilitation Physician in Bluffton, SC
• Providers in Bluffton, SC by specialty
• Physical Medicine & Rehabilitation Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.