Provider Demographics
NPI:1225504947
Name:WILLIAMS, SAMMY GRANT
Entity Type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:GRANT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COLLEGE BLVD W BLDG 2
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1099
Mailing Address - Country:US
Mailing Address - Phone:850-678-3277
Mailing Address - Fax:850-678-3211
Practice Address - Street 1:1001 COLLEGE BLVD W BLDG 2
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1099
Practice Address - Country:US
Practice Address - Phone:850-830-0376
Practice Address - Fax:850-678-3211
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4791237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist