MEDICARE: DR. DAVID RUSSELL WILLIAMS D.O.

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	1899	TN
2	207Q00000X	Family Medicine Physician	E5432	AR
3	207Q00000X	Family Medicine Physician	0102202214	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861686834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RUSSELL WILLIAMS D.O.

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	SUITE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-594-4006
Fax Number	:	757-594-2195

Provider Business Practice Location Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	SUITE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-594-4006
Fax Number	:	757-594-2195

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	12/20/2010

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Directions to “ DR. DAVID RUSSELL WILLIAMS D.O.” Practice Location

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