Provider Demographics
NPI:1699535641
Name:WILLIS, WILL JR
Entity type:Individual
Prefix:MR
First Name:WILL
Middle Name:
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2730
Mailing Address - Country:US
Mailing Address - Phone:504-333-9313
Mailing Address - Fax:
Practice Address - Street 1:1108 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-2730
Practice Address - Country:US
Practice Address - Phone:504-333-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management