Basic Information
| Provider Information | |||||||||
| NPI: | 1801021548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 W 8TH ST # C506 | ||||||||
| Address2: | CLINICAL CENTER, 1ST FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443837 | ||||||||
| FaxNumber: | 9042444508 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 W 8TH ST # C506 | ||||||||
| Address2: | CLINICAL CENTER, 1ST FLOOR | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443837 | ||||||||
| FaxNumber: | 9042444508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2009 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | TRN13885 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ME112260 | FL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005921600 | 05 | FL | MEDICAID | 003121723B | 05 | GA | MEDICAID | 14K97 | 01 | FL | BCBS | OTHER |