Active NPI
Bryan Christopher Willis, MD
- Pediatrics Physician
- Statesboro, GA
National Provider Identifier
1972039048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 91007
- Practice address
- 1570 Brampton Ave
Statesboro, GA 30458-0855 - Phone
- (912) 764-9196
- Fax
- (478) 237-9138
- NPI assigned
- May 10, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 91007 | GA | Primary |
Addresses
Primary practice location
1570 Brampton Ave
Statesboro, GA 30458-0855
Mailing address
1570 Brampton Ave
Statesboro, GA 30458-0855
Phone (912) 764-9196
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 91007 | GA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643932800000",
"number": "1972039048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1570 BRAMPTON AVE",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304580855",
"telephone_number": "912-764-9196",
"fax_number": "478-237-9138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1570 BRAMPTON AVE",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304580855",
"telephone_number": "912-764-9196",
"fax_number": "478-237-9138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "BRYAN",
"middle_name": "CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-05-10",
"last_updated": "2022-02-04",
"certification_date": "2022-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "91007",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.