Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2012-01741 | NC |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 34011467 | OH |
NPI | 1104147669 |
---|---|
Provider Name | Dr. Amanda Kay Williams |
First Address | London, OH 43140-1170 |
Second Address | London, OH 43140-1170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 16/09/2014 |