MEDICARE: MRS. QUANTARA L SMITH WILLIAMS MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1952605099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. QUANTARA L SMITH WILLIAMS MSW

Provider Business Mailing Address
First Line	:	PO BOX 181028
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32318-0010
Country	:	US
Telephone Number	:	850-322-4703
Fax Number	:	850-562-4626

Provider Business Practice Location Address
First Line	:	2323 HANSEN CT
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-4859
Country	:	US
Telephone Number	:	850-322-4703
Fax Number	:	850-562-4626

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

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	01/04/2011

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