Tom Vann Willis Jr., M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

10695 Issued in GA

Practice address

F L T C 1131 Chapel Crossing Rd
Brunswick, GA 31524-0001

Phone

(912) 280-5307

Fax

(912) 267-3196

NPI assigned

Feb 27, 2007

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 names 1

• Dr. Tom Vann Willis Jr. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851428056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 MEWS CIR",
            "city": "SAINT SIMONS ISLAND",
            "state": "GA",
            "postal_code": "315225153",
            "telephone_number": "912-638-3091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "F L T C 1131 CHAPEL CROSSING RD",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315240001",
            "telephone_number": "912-280-5307",
            "fax_number": "912-267-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "TOM",
        "middle_name": "VANN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "10695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TOM",
            "last_name": "WILLIS",
            "middle_name": "VANN",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Hannah Elizabeth Williams
• Misty Leigh Williams, M.D.
• Renee Elizabeth Williams, O.D.
• Steven Tillman Williams, MD
• Melanie Williamson
• Heather M Wilson, DMD
• Michelle Renee Wilson, DPT
• Shirley Diann Wilson, M.D.
• Stephanie Roselind Wilson, LPC
• Wings of Feathers Medical Clinic

• All providers in Brunswick, GA
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.