Active NPI
Gary L Willis, D.C.
- Chiropractor
- Alpharetta, GA
National Provider Identifier
1437148269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2788
- Practice address
- 317 N Main St
Alpharetta, GA 30009-2321 - Phone
- (770) 740-8740
- NPI assigned
- Oct 14, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2788 | GA | Primary |
| Chiropractor | 111N00000X | 1615 | AL |
Addresses
Primary practice location
317 N Main St
Alpharetta, GA 30009-2321
Mailing address
317 N Main St
Alpharetta, GA 30009-2321
Phone (770) 740-8740
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 581878777 | Other | GA | FED EMPL ID # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1615 | AL | MD | Counselor |
| 2788 | GA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542326400000",
"number": "1437148269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 N MAIN ST",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300092321",
"telephone_number": "770-740-8740"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 N MAIN ST",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300092321",
"telephone_number": "770-740-8740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "GARY",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-14",
"last_updated": "2018-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "GA",
"license": "2788",
"primary": true
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "AL",
"license": "1615",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED EMPL ID #",
"identifier": "581878777",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Alpharetta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.