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General NPI Number Information
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NPI Number | 1154958353
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Entity Type | Individual
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Provider Name | TYLER DANIEL WILLIAMS DO
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Gender | Male
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 6800 GLENWOOD AVE
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City | RALEIGH
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State | NC
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Zip | 27612-7133
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Country | US
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Telephone | 919-235-1939
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Fax | 919-235-1344
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Provider Business Mailing Address
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Address Line | PO BOX 602195
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City | CHARLOTTE
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State | NC
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Zip | 28260-2195
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Country | US
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Telephone | 877-498-4490
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Fax | 919-350-7687
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2023-02680
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License Number State | NC
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