Healthcare Provider Details

I. General information

NPI: 1679931497
Provider Name (Legal Business Name): LATONYA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463142 STATE ROAD 200
YULEE FL
32097-5554
US

IV. Provider business mailing address

463142 STATE ROAD 200
YULEE FL
32097-5554
US

V. Phone/Fax

Practice location:
  • Phone: 904-225-8280
  • Fax: 904-225-8232
Mailing address:
  • Phone: 904-225-8280
  • Fax: 904-225-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: