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1972588788

NPI Code Detail

MEDICARE: KATHLEEN ANN WILLIAMS MD

MEDICARE: KATHLEEN ANN WILLIAMS MD

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	207R00000X	Internal Medicine Physician	0428411	KS
2	208000000X	Pediatrics Physician	0428411	KS
3	207R00000X	Internal Medicine Physician	ME110163	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972588788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANN WILLIAMS MD

Provider Business Mailing Address
First Line	:	301 MEMORIAL MEDICAL PKWY
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5167
Country	:	US
Telephone Number	:	386-231-1091
Fax Number	:	386-231-1092

Provider Business Practice Location Address
First Line	:	301 MEMORIAL MEDICAL PKWY
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5167
Country	:	US
Telephone Number	:	386-231-1091
Fax Number	:	386-231-1092

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	09/18/2014

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Directions to “ KATHLEEN ANN WILLIAMS MD” Practice Location

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