Individual provider Active NPI

Donald Clinton Willis, M.D.

  • Obstetrics & Gynecology Physician
  • Johnson City, TN
National Provider Identifier
1902870611
Registry record updated Sep 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
ME30920 Issued in FL
Practice address
325 N State of Franklin Rd FL 1
Johnson City, TN 37604
Phone
(423) 439-7272
Fax
(423) 439-7235
NPI assigned
Feb 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME30920 FL Primary
Maternal & Fetal Medicine Physician 207VM0101X MD57056 TN

Addresses

Primary practice location

325 N State of Franklin Rd FL 1
Johnson City, TN 37604

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 439-7272

Other practice location 1

880 Madison Ave
Memphis, TN 38103-3409
Phone (901) 515-3700

Other identifiers 1

IdentifierTypeStateIssuer
039811000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, TN2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100830000950 FL Practitioner - Obstetrics/Gynecology 9133243066 Reassigns benefits to 1 organization
I20180803001110 TN Practitioner - Obstetrics/Gynecology 9133243066 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME30920FLMDObstetrics & Gynecology Physician
MD57056TNMDMaternal & Fetal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Regional One Physicians Inc Obstetrics & Gynecology CurrentSince Feb 15, 2022 Accepting new patients
Ut Regional One Physicians Inc CurrentSince Feb 15, 2022 Accepting new patients
Tallahassee Memorial Healthcare Inc Current Accepting new patients
Medical Education Assistance Corporation Obstetrics & Gynecology CurrentSince Apr 1, 2018 Accepting new patients
Phoebe Putney Memorial Hospital Inc Past Accepting new patients

Locations

1607 Saint James Ct
Ste 1
Tallahassee, FL 32308
Phone (850) 431-7021

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

325 N State of Franklin Rd
Fl 1
Johnson City, TN 37604
Phone (423) 439-7272

880 Madison Ave
Memphis, TN 38103
Phone (901) 515-3500

6215 Humphreys Blvd
Ste 201
Memphis, TN 38120
Phone (901) 866-8085

Interoperability endpoints

  • Direct secure messaging: donald.willis.1@8478.direct.athenahealth.com

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790726400000",
    "number": "1902870611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-439-7272",
            "fax_number": "423-439-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N STATE OF FRANKLIN RD FL 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-439-7272",
            "fax_number": "423-439-7235"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "880 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381033409",
            "country_code": "US",
            "telephone_number": "901-515-3700",
            "fax_number": "901-515-3509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DONALD",
        "middle_name": "CLINTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-17",
        "last_updated": "2026-09-30",
        "certification_date": "2026-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME30920",
            "primary": true
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "TN",
            "license": "MD57056",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "039811000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.