Healthcare Provider Details

I. General information

NPI: 1346608809
Provider Name (Legal Business Name): WILLIAMS MEDICAL GROUP PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6744 NW CACHE RD
LAWTON OK
73505-2702
US

IV. Provider business mailing address

777 NW 63RD ST FL 2
OKLAHOMA CITY OK
73116-7601
US

V. Phone/Fax

Practice location:
  • Phone: 580-536-9355
  • Fax: 580-536-9357
Mailing address:
  • Phone: 405-724-0574
  • Fax: 405-849-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TONY R HILL
Title or Position: OWNER
Credential:
Phone: 918-286-6331