Healthcare Provider Details

I. General information

NPI: 1336060102
Provider Name (Legal Business Name): BLUEWATER CARDIOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WINDWARD CIR
NICEVILLE FL
32578-4307
US

IV. Provider business mailing address

1200 WINDWARD CIR
NICEVILLE FL
32578-4307
US

V. Phone/Fax

Practice location:
  • Phone: 850-684-2546
  • Fax: 850-204-9014
Mailing address:
  • Phone: 850-684-2546
  • Fax: 850-204-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM TRUMAN WILLIAMS III
Title or Position: MANAGING MEMBER/OWNER
Credential: DO
Phone: 850-684-2546