Healthcare Provider Details

I. General information

NPI: 1841446549
Provider Name (Legal Business Name): JANA G. WILLIAMS, MD., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 CAMINO COYOTE
LAS CRUCES NM
88011
US

IV. Provider business mailing address

4181 CAMINO COYOTE
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-5912
  • Fax:
Mailing address:
  • Phone: 575-532-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2001-122
License Number StateNM

VIII. Authorized Official

Name: MRS. GLORIA V RIOS
Title or Position: OFFICER MANAGER
Credential:
Phone: 575-532-5912