W a Willis MD PA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

22449 Issued in NC

Legal business name

W A WILLIS MD PA

Practice address

2850 Village Dr
Suite 103
Fayetteville, NC 28304-3869

Phone

(910) 223-9801

Fax

(910) 223-9819

NPI assigned

Jun 6, 2012

Organization subpart

No

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

Authorized official

Name

Phyllis L Carter

Title

Office Adminstrator

Phone

(910) 391-4588

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William Allen Willis Jr., MD

  • Psychiatry Physician
  • Fayetteville, NC
  • NPI 1033179478
  Medicare reassignment NPD

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338940800000",
    "number": "1952662900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42005",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283092005",
            "telephone_number": "910-223-9801",
            "fax_number": "910-223-9819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2850 VILLAGE DR",
            "address_2": "SUITE 103",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043869",
            "telephone_number": "910-223-9801",
            "fax_number": "910-223-9819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W A WILLIS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2012-06-06",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "PHYLLIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE ADMINSTRATOR",
        "authorized_official_telephone_number": "910-391-4588"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "22449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8988133",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Leeanne Vrooman, OTR/L
• Jerry Wayne Vuncannon Jr., PH.D., LPC, NCC
• Simran Vuppala
• William Vurnakes, CRNA
• Kirsten Vuylsteke, RD
• W. H. Kingery DDS PA
• Stacy Lynne Wade, PHARMD
• Tasha Wade, LCSWA
• Kristina Waden
• Christy Taylor Wagner, MSW

• Psychiatry Physician in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.