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NPI Code Detail

MEDICARE: IVY WILLIAMS

MEDICARE:   IVY  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
1347C00000XPrivate Vehicle7892605NC

General Provider Information

NPI Number : 1104774280
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVY WILLIAMS
Provider Business Mailing Address
First Line : 1425 CENTIPEDE DR
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27801-3301
Country : US
Telephone Number : 252-289-5727
Fax Number :
Provider Business Practice Location Address
First Line : 1425 CENTIPEDE DR
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27801-3301
Country : US
Telephone Number : 252-289-5727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ IVY WILLIAMS ” Practice Location

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