Provider Demographics
NPI:1396201554
Name:WILLIAMS, AUSTIN GREGORY
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:GREGORY
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 1:11411 BLUE LILAC AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3711
Mailing Address - Country:US
Mailing Address - Phone:561-253-4769
Mailing Address - Fax:
Practice Address - Street 1:4211 W BOY SCOUT BLVD STE 450
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5724
Practice Address - Country:US
Practice Address - Phone:813-445-6550
Practice Address - Fax:813-445-6505
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor