Healthcare Provider Details

I. General information

NPI: 1083693972
Provider Name (Legal Business Name): STACY J WILLIAMS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N 28TH ST EMERGENCY MEDICINE DEPARTMENT
RICHMOND VA
23223-5332
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING/PAYER CONTRACTING
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-1780
  • Fax: 804-225-1705
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102202248
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: