Healthcare Provider Details

I. General information

NPI: 1982887451
Provider Name (Legal Business Name): WILLIAMS FAMILY AND SPORTS MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23366 FARMINGTON RD
FARMINGTON MI
48336-3102
US

IV. Provider business mailing address

23366 FARMINGTON RD
FARMINGTON MI
48336-3102
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-3333
  • Fax: 248-476-7123
Mailing address:
  • Phone: 248-476-3333
  • Fax: 248-476-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101 011913
License Number StateMI

VIII. Authorized Official

Name: DR. JOSEPH LAWSON WILLIAMS
Title or Position: MEMBER
Credential: D.O.
Phone: 248-476-3333