Healthcare Provider Details

I. General information

NPI: 1346247137
Provider Name (Legal Business Name): TED A WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 HONEYSUCKLE RD
DOTHAN AL
36305-1140
US

IV. Provider business mailing address

364 HONEYSUCKLE RD
DOTHAN AL
36305-1140
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-8656
  • Fax: 334-702-7047
Mailing address:
  • Phone: 334-794-8656
  • Fax: 334-702-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number00007243
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: