MEDICARE: ANDREA M 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	207Y00000X	Otolaryngology Physician	22182	SC

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	:	1992759971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA M WILLIAMS MD

Provider Business Mailing Address
First Line	:	8334 PINEVILLE MATTHEWS RD
Second Line	:	SUITE 103-151
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3774
Country	:	US
Telephone Number	:	704-544-6533
Fax Number	:	704-544-6583

Provider Business Practice Location Address
First Line	:	7006 SHANNON WILLOW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-1318
Country	:	US
Telephone Number	:	704-544-6533
Fax Number	:	704-544-6583

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/09/2010

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