Provider Demographics
NPI:1003968280
Name:WILLIAMS, AUDREA DONETA (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREA
Middle Name:DONETA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 W PERIMETER RD,
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE ANDREWS
Mailing Address - State:MD
Mailing Address - Zip Code:20762
Mailing Address - Country:US
Mailing Address - Phone:757-739-7939
Mailing Address - Fax:
Practice Address - Street 1:1060 W PERIMETER RD,
Practice Address - Street 2:
Practice Address - City:JOINT BASE ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762
Practice Address - Country:US
Practice Address - Phone:757-739-7939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program