Healthcare Provider Details

I. General information

NPI: 1679620835
Provider Name (Legal Business Name): WILLIAMS MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403E MORROW ST N
MENA AR
71953-4317
US

IV. Provider business mailing address

PO BOX 295
LOCKESBURG AR
71846-0295
US

V. Phone/Fax

Practice location:
  • Phone: 479-243-9024
  • Fax: 479-243-9248
Mailing address:
  • Phone: 870-289-5865
  • Fax: 870-289-6993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE2014
License Number StateAR

VIII. Authorized Official

Name: ROBERT S. WILLIAMS
Title or Position: OWNER
Credential: M.D.
Phone: 479-243-9024