MEDICARE: CODY WILLIAMS APRN

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
1	207RH0003X	Hematology & Oncology Physician	123901	AR
2	363L00000X	Nurse Practitioner	123901	AR

General Provider Information

NPI Number	:	1124651468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY WILLIAMS APRN

Provider Business Mailing Address
First Line	:	PO BOX 749495
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9495
Country	:	US
Telephone Number	:	239-432-8331
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 HIGDON FERRY RD STE B
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-6456
Country	:	US
Telephone Number	:	501-623-2731
Fax Number	:	501-623-1660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2020
Last Update Date	:	12/29/2022

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Directions to “ CODY WILLIAMS APRN” Practice Location

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