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General NPI Number Information
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NPI Number | 1972054732
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE AT NONA, LLC
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 10920 MOSS PARK RD SUITE 204
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City | ORLANDO
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State | FL
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Zip | 32832-6086
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Country | US
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Telephone | 321-250-7752
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Fax | 321-732-8440
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Provider Business Mailing Address
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Address Line | 2106 N ORANGE AVE SUITE 100
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City | ORLANDO
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State | FL
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Zip | 32804-5509
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Country | US
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Telephone | 407-459-1181
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Fax | 321-732-8440
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL WILLIAMS
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Credential | DO
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Telephone | 321-250-7752
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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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