MEDICARE: JONATHAN G WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	21235	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21235	OTHER	AL	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1518554666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN G WILLIAMS

Provider Business Mailing Address
First Line	:	2480 ROCKY RIDGE RD
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 ROCKY RIDGE RD
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-2833
Country	:	US
Telephone Number	:	205-979-1571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	12/23/2020

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