Healthcare Provider Details

I. General information

NPI: 1104740752
Provider Name (Legal Business Name): CODY ALAN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

9200 NW 39TH AVE STE 130-1020
GAINESVILLE FL
32606-7331
US

IV. Provider business mailing address

15248 NW 150TH RD APT 3093
ALACHUA FL
32615-5549
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 352-443-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: