Active NPI
Deborah Willis, M.D.
- Internal Medicine Physician
- Woodlawn, VA
National Provider Identifier
1508833286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 19080
- Practice address
- 5261 Carrollton Pike Ste B
Woodlawn, VA 24381-3030 - Phone
- (276) 238-8876
- Fax
- (276) 238-8886
- NPI assigned
- Mar 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 19080 | MS | Primary |
Addresses
Primary practice location
5261 Carrollton Pike Ste B
Woodlawn, VA 24381-3030
Mailing address
5261 Carrollton Pike Ste B
Woodlawn, VA 24381-3030
Phone (276) 238-8876
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C10361 | Other | GROUP ORGANIZATION PTAN | |
| 01955299 | Medicaid | MS | |
| DN2980 | Other | GROUP PTAN | |
| 26-1083931 | Other | TAX 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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19080 | MS | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411948800000",
"number": "1508833286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5261 CARROLLTON PIKE STE B",
"city": "WOODLAWN",
"state": "VA",
"postal_code": "243813030",
"telephone_number": "276-238-8876",
"fax_number": "276-238-8886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5261 CARROLLTON PIKE STE B",
"city": "WOODLAWN",
"state": "VA",
"postal_code": "243813030",
"telephone_number": "276-238-8876",
"fax_number": "276-238-8886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "DEBORAH",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-02",
"last_updated": "2014-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "19080",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP ORGANIZATION PTAN",
"identifier": "C10361",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01955299",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP PTAN",
"identifier": "DN2980",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "26-1083931",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodlawn, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.