Healthcare Provider Details

I. General information

NPI: 1417893157
Provider Name (Legal Business Name): JEREMY DAVIS WILLIAMS SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SE 23RD AVE
BOYNTON BEACH FL
33435-7289
US

IV. Provider business mailing address

401 SE 23RD AVE
BOYNTON BEACH FL
33435-7289
US

V. Phone/Fax

Practice location:
  • Phone: 615-920-3268
  • Fax: 615-920-3268
Mailing address:
  • Phone: 615-920-3268
  • Fax: 615-920-3268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: