Healthcare Provider Details

I. General information

NPI: 1306513122
Provider Name (Legal Business Name): T L WILLIAMS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2021
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 LASALLE RD
HYATTSVILLE MD
20782-3302
US

IV. Provider business mailing address

703 GLEN LAKE DR
BOWIE MD
20716-3564
US

V. Phone/Fax

Practice location:
  • Phone: 301-864-2333
  • Fax:
Mailing address:
  • Phone: 301-332-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TAHANI WILLIAMS
Title or Position: MD
Credential:
Phone: 301-332-9986