=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558473116
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAMILAH MARIE WILLIAMS M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 09/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7340 E BROAD ST STE B
-----------------------------------------------------
City | BLACKLICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43004-9625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-864-8000
-----------------------------------------------------
Fax | 614-864-3036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5450 FRANTZ RD STE 250
-----------------------------------------------------
City | DUBLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43016-4134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35088005
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------