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General NPI Number Information
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NPI Number | 1780945907
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Entity Type | Organization
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Legal Business Name | WILLIAMS FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 06/05/2012
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 1 GARTON PLZ
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City | WESTON
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State | WV
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Zip | 26452-2128
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Country | US
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Telephone | 304-517-1301
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Fax | 304-517-1304
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Provider Business Mailing Address
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Address Line | 1 GARTON PLZ
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City | WESTON
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State | WV
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Zip | 26452-2128
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Country | US
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Telephone | 304-517-1301
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Fax | 304-517-1304
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JEREMY S WILLIAMS
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Credential | MD
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Telephone | 304-517-1301
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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 | 23084
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License Number State | WV
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