Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 20535 | AL |
NPI | 1184680472 |
---|---|
Provider Name | Dr. Kim J Williams |
First Address | Opelika, AL 36803-4283 |
Second Address | Opelika, AL 36801-5452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 13/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
510-00380 | BLUE CROSS OF AL PROV # (01) | AL |
G46272 | (02) | AL |