Healthcare Provider Details

I. General information

NPI: 1275853749
Provider Name (Legal Business Name): KWANI DEANN WILLIAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 2022
APO AP
96264-2022
US

IV. Provider business mailing address

UNIT 2022
APO AP
96264-2022
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-0409
  • Fax:
Mailing address:
  • Phone: 315-782-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301511999
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP2934
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: