Healthcare Provider Details

I. General information

NPI: 1548219272
Provider Name (Legal Business Name): TIMOTHY G. WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARENGO ST
FLORENCE AL
35630-6033
US

IV. Provider business mailing address

PO BOX 757
FLORENCE AL
35631-0757
US

V. Phone/Fax

Practice location:
  • Phone: 256-768-9191
  • Fax:
Mailing address:
  • Phone: 256-764-9697
  • Fax: 256-764-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number00015543
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: