Basic Information
| Provider Information | |||||||||
| NPI: | 1194788729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | WILLIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12366 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352022366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057886688 | ||||||||
| FaxNumber: | 2057880305 | ||||||||
| Practice Location | |||||||||
| Address1: | 832 PRINCETON AVE SW | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057886688 | ||||||||
| FaxNumber: | 2057880305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11325 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | C23574 | 01 | AL | VIVA INSURANCE | OTHER | 009976125 | 05 | AL | MEDICAID | 009976135 | 05 | AL | MEDICAID | 110209683 | 01 | AL | RR MEDICARE | OTHER | 512-20081 | 01 | AL | BCBS AL | OTHER | C23574 | 01 | AL | HEALTHSPRING OF ALABAMA | OTHER |