Healthcare Provider Details

I. General information

NPI: 1700724366
Provider Name (Legal Business Name): WILLIAMS RECEPTIVE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S INDIAN RIVER DR STE 202
FORT PIERCE FL
34950-4353
US

IV. Provider business mailing address

2810 N CHURCH ST PMB 79505
WILMINGTON DE
19802-4447
US

V. Phone/Fax

Practice location:
  • Phone: 855-526-6766
  • Fax: 800-381-4814
Mailing address:
  • Phone: 855-526-6766
  • Fax: 800-381-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER GILL
Title or Position: CEO
Credential:
Phone: 406-560-7083