Provider Demographics
NPI:1154376259
Name:WILLIS, CARL ROGASTON (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:ROGASTON
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2004 HAYES ST STE 800
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2659
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:615-329-0579
Practice Address - Street 1:322 22ND AVE N STE 400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1870
Practice Address - Country:US
Practice Address - Phone:615-320-5090
Practice Address - Fax:615-320-1225
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN037952207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4090607OtherBCBS OF TN IND PROVIDER #
TN3894844Medicaid
TNI07721Medicare UPIN
TN4090607OtherBCBS OF TN IND PROVIDER #