Healthcare Provider Details

I. General information

NPI: 1073067856
Provider Name (Legal Business Name): DERAY JUNIOR WILLIAMS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DERAY JUNIOR WILLIAMS CRNP

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 FRIENDSHIP RD
TALLASSEE AL
36078
US

IV. Provider business mailing address

875 FRIENDSHIP RD
TALLASSEE AL
36078-1255
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-3111
  • Fax: 334-283-1060
Mailing address:
  • Phone: 337-283-3111
  • Fax: 334-283-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-130381
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: