Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101241909 | VA |
N | 207P00000X | Emergency Physician | 39977 | TN |
Y | 207R00000X | Internist | 2021-00786 | NC |
Y | 111NI0900X | Internist | 2021-00786 | NC |
N | 207R00000X | Internist | MD39977 | TN |
N | 111NI0900X | Internist | MD39977 | TN |
N | 208000000X | Pediatrician | MD39977 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | MD39977 | TN |
NPI | 1194768382 |
---|---|
Provider Name | Dr. Gordon Frank Williams |
First Address | Eden, NC 27288-5010 |
Second Address | Eden, NC 27288-5010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194768382 | (05) | VA |
3334467 | (05) | TN |
3334468 | (05) | TN |
4108063 | BLUE CROSS (01) | TN |
4153169 | BLUE CROSS (01) | TN |
5910413 | (05) | NC |
P00254453 | RRGA (01) | TN |