Healthcare Provider Details

I. General information

NPI: 1780688010
Provider Name (Legal Business Name): DAVID BERNARD WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SYCAMORE ST
WILLIAMSBURG KY
40769-1153
US

IV. Provider business mailing address

PO BOX 1325
CORBIN KY
40702-1325
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-8244
  • Fax: 606-549-0354
Mailing address:
  • Phone: 606-526-8131
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26071
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: