Basic Information
| Provider Information | |||||||||
| NPI: | 1841251253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS-VAUGHN | ||||||||
| FirstName: | IMANI | ||||||||
| MiddleName: | NAJUMA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILLIAMS | ||||||||
| OtherFirstName: | IMANI | ||||||||
| OtherMiddleName: | NAJUMA | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 333 N DOBSON RD STE 15 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852244412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802828336 | ||||||||
| FaxNumber: | 4802828365 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N DOBSON RD STE 15 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852244412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802828336 | ||||||||
| FaxNumber: | 4802828365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 09/12/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 7045160001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7047150001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7629170001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 705360001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7034950001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 207Q00000X | 32653 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | 332B00000X | 7046960001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7209350001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 871229 | 05 | AZ | MEDICAID |