Provider Demographics
NPI:1073067856
Name:WILLIAMS, DERAY JUNIOR (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DERAY
Middle Name:JUNIOR
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:MR
Other - First Name:DERAY
Other - Middle Name:JUNIOR
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:875 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1255
Mailing Address - Country:US
Mailing Address - Phone:337-283-3111
Mailing Address - Fax:334-283-1060
Practice Address - Street 1:875 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078
Practice Address - Country:US
Practice Address - Phone:334-283-3111
Practice Address - Fax:334-283-1060
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-130381363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL236250Medicaid