=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013377365
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMEM WILLIAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2016
-----------------------------------------------------
Last Update Date | 08/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12724 GRAN BAY PKWY W STE 410
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32258-9486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-371-9624
-----------------------------------------------------
Fax | 239-232-6100
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12724 GRAN BAY PKWY W STE 410
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32258-9486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-371-9624
-----------------------------------------------------
Fax | 239-232-6100
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW005698
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW16586
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------