Healthcare Provider Details

I. General information

NPI: 1861693897
Provider Name (Legal Business Name): DAVID B WILLIAMS MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SYCAMORE ST
WILLIAMSBURG KY
40769-1153
US

IV. Provider business mailing address

403 SYCAMORE ST
WILLIAMSBURG KY
40769-1153
US

V. Phone/Fax

Practice location:
  • Phone: 606-549-8244
  • Fax: 606-549-0354
Mailing address:
  • Phone: 606-549-8244
  • Fax: 606-549-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BERNARD WILLIAMS
Title or Position: PHYSICIAN
Credential: MD
Phone: 606-549-8244