Provider Demographics
NPI:1104893809
Name:REESE WILLIS, CELESTE (MD)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:REESE WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:S
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:944 NARROWS POINT DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8672
Mailing Address - Country:US
Mailing Address - Phone:205-291-8842
Mailing Address - Fax:205-235-9592
Practice Address - Street 1:401 TUSCALOOSA AVE SW STE 210
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1486
Practice Address - Country:US
Practice Address - Phone:205-291-8842
Practice Address - Fax:205-235-9592
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26026207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
167582201OtherFEDERAL BLACK LUNG
AL51536439OtherBCBS
783802OtherAETNA
AL009938946Medicaid
AL631053058026OtherTRICARE
ALI16326OtherHEALTHSPRING OF AL
ALP00366475Medicare PIN
783802OtherAETNA
167582201OtherFEDERAL BLACK LUNG