Healthcare Provider Details

I. General information

NPI: 1477132132
Provider Name (Legal Business Name): EMMA CORRINE DRACH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA C WILLIAMS DO

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLONNADE DR STE 200
PONTE VEDRA FL
32081-6236
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-686-7577
  • Fax: 904-390-7513
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02007957A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS24040
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.078882
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036166767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: