Healthcare Provider Details

I. General information

NPI: 1376824722
Provider Name (Legal Business Name): CHIMERE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

IV. Provider business mailing address

2014 14TH ST APT. B
PHENIX CITY AL
36867-5433
US

V. Phone/Fax

Practice location:
  • Phone: 706-323-0174
  • Fax: 706-256-3264
Mailing address:
  • Phone: 706-992-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: