Provider Demographics
NPI:1295627610
Name:DILLARD, WILLIE I
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:
Last Name:DILLARD
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:WILLIE
Other - Middle Name:
Other - Last Name:DILLARD
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 CENTRAL PLZ S
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1415
Mailing Address - Country:US
Mailing Address - Phone:330-265-0080
Mailing Address - Fax:
Practice Address - Street 1:101 CENTRAL PLZ S
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1415
Practice Address - Country:US
Practice Address - Phone:330-265-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker