Healthcare Provider Details

I. General information

NPI: 1275465619
Provider Name (Legal Business Name): DEANNA AMIAH WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

45 ALABAMA AVE
JACKSONVILLE FL
32218-2672
US

IV. Provider business mailing address

12078 HIDDEN HILLS DR
JACKSONVILLE FL
32225-1601
US

V. Phone/Fax

Practice location:
  • Phone: 904-304-9810
  • Fax: 904-508-0173
Mailing address:
  • Phone: 904-304-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: