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Provider Information for 1073013298


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COURTNEY WILLIS


Sex: Female

NPI: 1073013298
Last Updated: 2023-04-19
Certification Date: 2023-04-19

Details

NameValue
NPI1073013298
Enumeration Date2018-02-14
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 108 MUMSFORD CT
UNION CITY, GA 30291-3471
United States

Phone: 404-642-7565 | Fax:
 
Primary Practice Address 108 MUMSFORD CT
UNION CITY, GA 30291-3471
United States

Phone: 404-642-7565 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101Y00000X - Counselor GALPC013142