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General NPI Number Information
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NPI Number | 1710591656
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Entity Type | Organization
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Legal Business Name | WILLIAMS MEDICAL PRACTICE LLC
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 1029 MEDICAL CENTER CIR STE 202
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City | MAYFIELD
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State | KY
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Zip | 42066-1189
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Country | US
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Telephone | 270-251-4551
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Fax | 270-251-4551
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Provider Business Mailing Address
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Address Line | 1029 MEDICAL CENTER CIR STE 202
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City | MAYFIELD
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State | KY
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Zip | 42066-1189
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Country | US
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Telephone | 270-247-7795
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Fax | 270-251-4551
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Authorized Official
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Title or Position | MBR
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Name | DR. WAYNE E WILLIAMS
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Credential | MD
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Telephone | 270-247-7795
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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 |
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License Number State |
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