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General NPI Number Information
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NPI Number | 1629407655
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Entity Type | Organization
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Legal Business Name | WILLOUGHBY C. WILLIAMS, LLC, D.B.A.-DISRICT MEDICAL CENTER
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 1175 NE 125TH ST SUITE 310
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5015
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Country | US
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Telephone | 305-454-7656
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Fax | 305-365-3698
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Provider Business Mailing Address
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Address Line | 1175 NE 125TH ST SUITE 310
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City | NORTH MIAMI
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State | FL
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Zip | 33161-5015
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Country | US
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Telephone | 305-454-7656
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Fax | 305-365-3698
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Authorized Official
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Title or Position | MANAGER
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Name | GERALDINE TISDOL-CLARK
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Credential |
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Telephone | 305-467-1989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | FL
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