Healthcare Provider Details

I. General information

NPI: 1285602961
Provider Name (Legal Business Name): MELISSA SUSAN WILLIAMS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14714 ST STEPHENS AVE
CHATOM AL
36518
US

IV. Provider business mailing address

PO BOX 1237
CHATOM AL
36518
US

V. Phone/Fax

Practice location:
  • Phone: 251-847-6262
  • Fax: 251-847-6277
Mailing address:
  • Phone: 251-847-6262
  • Fax: 251-847-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1060587
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: