MEDICARE: MISSION MEDICAL FAMILY PRACTICE INC.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1669364808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION MEDICAL FAMILY PRACTICE INC.

Provider Business Mailing Address
First Line	:	1283 SW STATE ROAD 47 STE 103
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0490
Country	:	US
Telephone Number	:	386-271-2993
Fax Number	:	904-442-8842

Provider Business Practice Location Address
First Line	:	1283 SW STATE ROAD 47 STE 103
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-0490
Country	:	US
Telephone Number	:	386-623-1871
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ DIRECTOR
Name	:	MEGHANN WILLIAMSON
Credential	:	APRN
Telephone Number	:	386-271-2993

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	03/12/2026

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