Jeffrey Todd Willis, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

12556 Issued in MS

Practice address

1003 Holland Ave Ste 104
Philadelphia, MS 39350-2180

Phone

(601) 656-0010

Fax

(601) 656-0313

NPI assigned

Jul 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neshoba Family Medical Clinic

  • Pain Medicine Physician
  • Philadelphia, MS
  • NPI 1003092818
  NPD (past)

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1639100340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 HOLLAND AVE STE 104",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502180",
            "telephone_number": "601-656-0010",
            "fax_number": "601-656-0313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 HOLLAND AVE STE 104",
            "city": "PHILADELPHIA",
            "state": "MS",
            "postal_code": "393502180",
            "telephone_number": "601-656-0010",
            "fax_number": "601-656-0313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JEFFREY",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MS",
            "license": "12556",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0114279",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandy Elizabeth White, LPTA
• Amy Wilborn, PTA
• Michael Wilcher, PT
• Stephanie L. Wilcher, O.T.
• Jenny Lynn Wilkerson, RPH
• Rana Winstead, FNP-C
• Terry Mark Winstead, OTR
• Anna Katherine Woods, FNP-C
• April Leigh Wren
• Melissa Young, OT

• General Practice Physician in Philadelphia, MS
• Providers in Philadelphia, MS by specialty
• General Practice Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2020; 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.