Provider Demographics
NPI:1083693972
Name:WILLIAMS, STACY J (DO)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:1500 N 28TH ST
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5332
Practice Address - Country:US
Practice Address - Phone:804-225-1780
Practice Address - Fax:804-225-1705
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202248207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0158204604OtherBCBS
VA1083693972Medicaid
MI1083693972Medicaid
MIG83259Medicare UPIN
MI0158204604OtherBCBS
MIQ24594139Medicare ID - Type UnspecifiedMHP OKW-SJMM