Provider Demographics
NPI:1003425919
Name:WILLIAMS, AUSTIN LEE (CAC/OSTEO MD-STUDENT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CAC/OSTEO MD-STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7748 RUSTLING PINES DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-3007
Mailing Address - Country:US
Mailing Address - Phone:850-407-0607
Mailing Address - Fax:
Practice Address - Street 1:1398 SW 160TH
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-290-8446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program