| Organization Name: | J. TODD WILLIS, MD CLINIC |
| NPI Number: | 1053788240 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHERYL LEANN SAVELL (CREDENTIALING COORDINATOR) |
| Mailing Address: | 1003 Holland Avenue Suite 104 Philadelphia |
| State: | MS US |
| Postal Code: | 393502180 |
| Phone Number: | 6016560010 |
| Fax Number: | 6016560313 |
| NPI Enumeration Date: | 08/24/2015 |
| NPI Last Update Date: | 08/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 12556 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |