Provider Demographics
NPI:1861798696
Name:WILLIS, RHETT N JR (MD)
Entity type:Individual
Prefix:DR
First Name:RHETT
Middle Name:N
Last Name:WILLIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1410 INCARNATION DR STE 205A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-5708
Mailing Address - Country:US
Mailing Address - Phone:434-227-5333
Mailing Address - Fax:434-483-5040
Practice Address - Street 1:1410 INCARNATION DR STE 205A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-5708
Practice Address - Country:US
Practice Address - Phone:434-227-5333
Practice Address - Fax:434-483-5040
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2020-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT10240804-1205208200000X
VA0101254231208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery