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General NPI Number Information
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NPI Number | 1700724366
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Entity Type | Organization
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Legal Business Name | WILLIAMS RECEPTIVE PA A FLORIDA PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 03/24/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 130 S INDIAN RIVER DR STE 202
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City | FORT PIERCE
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State | FL
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Zip | 34950-4353
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Country | US
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Telephone | 406-560-7083
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Fax |
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Provider Business Mailing Address
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Address Line | 2810 N CHURCH ST UNIT 26129
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City | WILMINGTON
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State | DE
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Zip | 19802-4447
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Country | US
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Telephone | 406-560-7083
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AMBER GILL
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Credential |
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Telephone | 406-560-7083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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