Healthcare Provider Details

I. General information

NPI: 1669068003
Provider Name (Legal Business Name): LINDA S FORNEY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 DEER TRAIL DR
WESTERVILLE OH
43082-6409
US

IV. Provider business mailing address

2610 MCDANIEL CT
GROVE CITY OH
43123-2152
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-0130
  • Fax:
Mailing address:
  • Phone: 614-871-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: