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NPI Code Detail

MEDICARE: DORIS WILLIAMS

MEDICARE: DORIS WILLIAMS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician25-414534

General Provider Information

NPI Number : 1063932861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORIS WILLIAMS
Provider Business Mailing Address
First Line : 9720 GLENBRIDGE WAY
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-4330
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8604 CLIFF CAMERON DR STE 180
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-8508
Country : US
Telephone Number : 888-392-8642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2017
Last Update Date : 10/01/2025

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