Provider Demographics
NPI:1033342290
Name:WILLIAMS, PENNY ANNETTE (CMF)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:ANNETTE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 376
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-0376
Mailing Address - Country:US
Mailing Address - Phone:336-449-7357
Mailing Address - Fax:336-449-7592
Practice Address - Street 1:1230 SPRINGWOOD CHURCH RD
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-2667
Practice Address - Country:US
Practice Address - Phone:336-449-7357
Practice Address - Fax:336-449-7592
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC26362335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795315Medicaid