Provider Demographics
NPI:1417023813
Name:WILLIAMS, CAROL M (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305
Mailing Address - Country:US
Mailing Address - Phone:334-836-1212
Mailing Address - Fax:334-836-1888
Practice Address - Street 1:480 HONEYSUCKLE RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305
Practice Address - Country:US
Practice Address - Phone:334-836-1212
Practice Address - Fax:334-836-1888
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1050450363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P84170Medicare UPIN