Healthcare Provider Details

I. General information

NPI: 1720388317
Provider Name (Legal Business Name): CHARLES E. WILLIAMS, M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 ALOMA AVE
WINTER PARK FL
32792-3702
US

IV. Provider business mailing address

3027 ALOMA AVE
WINTER PARK FL
32792-3702
US

V. Phone/Fax

Practice location:
  • Phone: 407-678-6466
  • Fax: 407-678-6710
Mailing address:
  • Phone: 407-678-6466
  • Fax: 407-678-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY P. SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 407-678-6466