Healthcare Provider Details

I. General information

NPI: 1801338579
Provider Name (Legal Business Name): BERNARD M. WILLIAMS, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2016
Last Update Date: 11/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 LOBLOLLY LN
CHARLOTTESVILLE VA
22903-7655
US

IV. Provider business mailing address

560 LOBLOLLY LN
CHARLOTTESVILLE VA
22903-7655
US

V. Phone/Fax

Practice location:
  • Phone: 434-296-4564
  • Fax:
Mailing address:
  • Phone: 434-296-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0101017020
License Number StateVA

VIII. Authorized Official

Name: DR. BERNARD MOORE WILLIAMS
Title or Position: PHYSICIAN
Credential: MD
Phone: 434-296-4564