Healthcare Provider Details

I. General information

NPI: 1992759971
Provider Name (Legal Business Name): ANDREA M WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7006 SHANNON WILLOW RD
CHARLOTTE NC
28226-1318
US

IV. Provider business mailing address

8334 PINEVILLE MATTHEWS RD SUITE 103-151
CHARLOTTE NC
28226-3774
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-6533
  • Fax: 704-544-6583
Mailing address:
  • Phone: 704-544-6533
  • Fax: 704-544-6583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22182
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: