Provider Demographics
NPI:1417395112
Name:WILLIAMS, SANDRA SUE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SUE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2868 ACTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2502
Mailing Address - Country:US
Mailing Address - Phone:205-968-8360
Mailing Address - Fax:205-968-8361
Practice Address - Street 1:801 CHURCH ST NE
Practice Address - Street 2:SUITE 1
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-2472
Practice Address - Country:US
Practice Address - Phone:256-355-4461
Practice Address - Fax:256-355-4370
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101136163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse