Basic Information
| Provider Information | |||||||||
| NPI: | 1346201126 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | ANASTASIA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442668268 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8180 STONEWALL SHOPS SQ | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201553891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033650227 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0101230823 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 10231464 | 01 | VA | AMERIGROUP | OTHER | 234900 | 01 | KAISER | OTHER | 283358 | 01 | AMERIGROUP | OTHER | 010057485 | 05 | VA | MEDICAID | 104124 | 01 | ANTHEM HEALTHKEEPERS | OTHER | 8121798 | 01 | MAMSI OPTIMUM CHOICEMDIPA | OTHER | 8121798 | 01 | VA | ALLIANCE | OTHER | 2616290 | 01 | AETNA HMO POS | OTHER | 7137266 | 01 | VA | AETNA PPO | OTHER | 104124 | 01 | ANTHEM BCBC | OTHER | J76300001 | 01 | CAREFIRST | OTHER |