Healthcare Provider Details

I. General information

NPI: 1366544827
Provider Name (Legal Business Name): WAYNE E. WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 MEDICAL CENTER CIR STE 202
MAYFIELD KY
42066-1189
US

IV. Provider business mailing address

1029 MEDICAL CENTER CIR STE 202
MAYFIELD KY
42066-1189
US

V. Phone/Fax

Practice location:
  • Phone: 270-247-7795
  • Fax: 270-251-4551
Mailing address:
  • Phone: 270-247-7795
  • Fax: 800-574-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21371
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: