Healthcare Provider Details

I. General information

NPI: 1396918579
Provider Name (Legal Business Name): TOWN CENTER FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HOSPITAL DR STE 290
PALM COAST FL
32164-2380
US

IV. Provider business mailing address

PO BOX 3123
ST AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 386-473-7977
  • Fax: 386-437-7732
Mailing address:
  • Phone: 904-824-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME61253
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberME61253
License Number StateFL

VIII. Authorized Official

Name: DR. DONNETTE WILLIAMS
Title or Position: OWNER
Credential: MD
Phone: 386-437-7977