DR. MARK L WILLIS (NPI# 1740269612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740269612 |
| Entity Type | Individual |
| Full Name | DR. MARK L WILLIS |
| Credential | MD |
| Practice Address |
208 Haven Dr Southeast Pain Mgmt Center Dothan AL 36301-2909 |
| Mailing Address |
1108 Ross Clark Circle Southeast Pain Mgmt Center Dothan AL 36301 |
| Practice Telephone | 3347938196 |
| Practice Fax Number | 3346994757 |
| Mailing Telephone | 3347938196 |
| Mailing Fax Number | 3346994757 |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2017-05-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | 00025952 | AL | Allopathic & Osteopathic Physicians |
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
00025952 | AL | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
00025952 | AL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| BCBS OF AL | 51521334 | 01 | |
| GA | MEDICAID | 622443016A | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326136326 | Mark A Willis | Dentist | 5604 Ellsworth Rd, Fort Smith, AR 72903-3224 | 2006-10-11 |
| 1154838886 | Mark Willis | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-03 |
| 1649423617 | Mark Willis | Otolaryngology | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2008-11-03 |
| 1326137514 | Mark C Willis Jr. | Orthopaedic Surgery | 1250 E Marshall St, Orthopaedic Surgery, Richmond, VA 23298-0510 | 2006-10-12 |
| 1215965751 | Mark A Willis | Physical Therapist | 1514 Owens St, Gadsden, AL 35904-4938 | 2006-06-30 |
| Street Address |
208 HAVEN DR SOUTHEAST PAIN MGMT CENTER |
| City | DOTHAN |
| State | AL |
| Zip Code | 36301-2909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043862931 | Pharmacy Center South LLC | Pharmacy | 2826 Ross Clark Circle, Suite 103, Dothan, AL 36301 | 2019-07-11 |
| 1851879167 | Attallah Cotton | Social Worker | 101 Eastridge Dr, Dothan, AL 36301 | 2018-07-31 |
| 1225522709 | Nichole Johnson Prestwood | Nurse Practitioner | 2431 W Main St Ste 501, Dothan, AL 36301 | 2018-06-19 |
| 1750805818 | Kimberly Danielle Austin | Speech-Language Pathologist | 404 Darlington Cir, Dothan, AL 36301 | 2017-07-31 |
| 1952794885 | Lori P. Granberry | Pharmacist | 2131 Ross Clark Circle, Dothan, AL 36301 | 2015-03-17 |
| 1801286059 | Robert Cody Russell | Nurse Practitioner | 1118 Ross Clark Circle, Suite 100, Dothan, AL 36301 | 2015-01-27 |
| 1720407646 | Michael Kreger | Anesthesiology | 1118 Ross Clark Cir Ste 700, Dothan, AL 36301 | 2014-04-08 |
| 1063851277 | Carlos Stanford Clark II | Family Medicine | 201 Doctors Drive, Dothan, AL 36301 | 2013-06-20 |
| 1639489313 | Robert Fort Hambaugh Jr. | Specialist | 712 Woodland Drive, Dothan, AL 36301 | 2010-10-15 |
| 1588894976 | Atwill Lamar Miller Jr. | Urology | 1908 Fairview Avenue, Dothan, AL 36301 | 2009-07-20 |
| Find all providers in zip 36301 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548757420 | Dpi of Alabama LLC | Pain Medicine | 3310 Kelly Creek Rd, Moody, AL 35004 | 2018-04-17 |
| 1730313156 | Auburn Pain Specialists LLC | Pain Medicine | 890 North Dean Rd, Suite 100, Auburn, AL 36830 | 2009-05-13 |
| 1497989180 | Aaron T. Shinkle | Pain Medicine | 660 Mcqueen Smith Rd N Ste E, Prattville, AL 36066-7559 | 2009-05-08 |
| 1386791697 | Central Alabama Pain Management Center, P.C. | Pain Medicine | 1709 Forest Ave, Montgomery, AL 36106-1543 | 2007-01-05 |
| 1255393393 | Medha A Pradhan | Pain Medicine | 7205 Copperfield Dr, Montgomery, AL 36117-7101 | 2006-04-04 |
| 1447210844 | Painsouth Inc | Pain Medicine | 1528 Carraway Blvd, Suite 402, Birmingham, AL 35234 | 2006-03-28 |
| 1225098163 | Michael Scott Kendrick | Pain Medicine | 1020 26th St S, Suite 100, Birmingham, AL 35205-2412 | 2006-03-24 |
| 1235671231 | Covenant Pain Therapies Center, LLC | Pain Medicine | 3007 Memorial Pkwy Sw, Huntsville, AL 35801-5393 | 2016-11-08 |
| 1467866624 | Pain Treatment Centers of Alabama, PC | Pain Medicine | 470 Taylor Rd, Suite 201, Montgomery, AL 36117-3563 | 2014-06-16 |
| 1467603670 | Jacob Anthony Vella | Pain Medicine | 488 Saint Lukes Dr, Montgomery, AL 36117 | 2008-10-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.