Healthcare Provider Details

I. General information

NPI: 1679165823
Provider Name (Legal Business Name): BLAIR WILLIAMS NEIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIDNEY BLAIR WILLIAMS NP

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 MAIN ST
GLOUCESTER VA
23061-5194
US

IV. Provider business mailing address

280 W EUCLID BLVD
WEST POINT VA
23181-9378
US

V. Phone/Fax

Practice location:
  • Phone: 804-824-9153
  • Fax:
Mailing address:
  • Phone: 804-815-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0024179957
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: