Healthcare Provider Details

I. General information

NPI: 1578657268
Provider Name (Legal Business Name): TIMMY OWEN WILLIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JACKSON STREET
GROVE HILL AL
36451
US

IV. Provider business mailing address

571 COUNTY RD. 212
VALLEY GRANDE AL
36701-3709
US

V. Phone/Fax

Practice location:
  • Phone: 251-275-3191
  • Fax:
Mailing address:
  • Phone: 334-877-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-052962
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: