Active NPI
Robert K. Willis, M.ED
- School Counselor
- Ellenwood, GA
National Provider Identifier
1750931200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Counselor
- License
- 1366328
- Practice address
- 2818 Appaloosa Run
Ellenwood, GA 30294-3968 - Phone
- (404) 630-5301
- NPI assigned
- Sep 17, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | 1366328 | GA | Primary |
Addresses
Primary practice location
2818 Appaloosa Run
Ellenwood, GA 30294-3968
Mailing address
2818 Appaloosa Run
Ellenwood, GA 30294-3968
Phone (404) 630-5301
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)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1366328 | GA | MD | School Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568678400000",
"number": "1750931200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2818 APPALOOSA RUN",
"city": "ELLENWOOD",
"state": "GA",
"postal_code": "302943968",
"telephone_number": "404-630-5301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2818 APPALOOSA RUN",
"city": "ELLENWOOD",
"state": "GA",
"postal_code": "302943968",
"telephone_number": "404-630-5301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "ROBERT",
"middle_name": "K.",
"credential": "M.ED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-09-17",
"last_updated": "2019-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YS0200X",
"taxonomy_group": "",
"desc": "Counselor, School",
"state": "GA",
"license": "1366328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellenwood, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.