Basic Information
| Provider Information | |||||||||
| NPI: | 1982255824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 600 TOWNE CENTRE BLVD STE 403 | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281348475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9807851113 | ||||||||
| FaxNumber: | 9807851114 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 TOWNE CENTRE BLVD STE 403 | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281348475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9807851113 | ||||||||
| FaxNumber: | 9807851114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2019 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-19-93326 | NC | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.