Healthcare Provider Details

I. General information

NPI: 1013430438
Provider Name (Legal Business Name): CANDY M WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14634 SAINT STEPHENS AVE
CHATOM AL
36518-6711
US

IV. Provider business mailing address

PO BOX 1237
CHATOM AL
36518-1237
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-118490
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: