MEDICARE: PAMELA BERRY WILLIAMS M.D.

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	2018-02994	NC
2	207Q00000X	Family Medicine Physician	297055	NY
3	207Q00000X	Family Medicine Physician	E-11911	AR
4	207Q00000X	Family Medicine Physician	01081567A	IN
5	207Q00000X	Family Medicine Physician	S0407	TX
6	207Q00000X	Family Medicine Physician	4301065900	MI

General Provider Information

NPI Number	:	1821191180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA BERRY WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	5555 CONNER ST STE 2691
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48213-3812
Country	:	US
Telephone Number	:	313-692-8400
Fax Number	:	313-692-8431

Provider Business Practice Location Address
First Line	:	5555 CONNER ST
Second Line	:	SUITE 2691
City	:	DETROIT
State	:	MI
Zip	:	48213-3448
Country	:	US
Telephone Number	:	313-579-4000
Fax Number	:	313-579-4063

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	11/18/2021

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