Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 021612 | GA |
N | 111NI0900X | Internist | 021612 | GA |
Y | 207RH0002X | Hospice and Palliative Medicine | 39016 | SC |
NPI | 1295789733 |
---|---|
Provider Name | Dr. Michael L Willoughby |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29401-1113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D41826 | (02) | GA |
G21612 | (05) | SC |