Provider Demographics
NPI:1508847856
Name:WILLIAMS, CLINTON SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:SCOTT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LOWELL DR SE
Mailing Address - Street 2:STE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-535-5940
Mailing Address - Fax:256-535-5959
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:STE 107
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:256-535-5940
Practice Address - Fax:256-535-5954
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
631223038OtherTAX IDENTIFICATION NO
0005509737OtherAETNA
AL51008592OtherBLUE CROSS BLUE SHIELD
080142310OtherRAILROAD MEDICARE
AL51008592OtherBLUE CROSS BLUE SHIELD
631223038OtherTAX IDENTIFICATION NO