Healthcare Provider Details

I. General information

NPI: 1003419953
Provider Name (Legal Business Name): TIFFANY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 MEDINA RD STE 2
MEDINA OH
44256-5333
US

IV. Provider business mailing address

1621 MEDINA RD STE 2
MEDINA OH
44256-5333
US

V. Phone/Fax

Practice location:
  • Phone: 330-241-4444
  • Fax:
Mailing address:
  • Phone: 330-241-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: