Healthcare Provider Details

I. General information

NPI: 1407816341
Provider Name (Legal Business Name): SCOTT SHIELDS WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE STE 4B
PENSACOLA FL
32504-8785
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2280
  • Fax: 850-416-2258
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-539-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberME165219
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: