Provider Demographics
NPI:1508872516
Name:WILLIAMS, LAUREN D (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10064 SW 164TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4884
Mailing Address - Country:US
Mailing Address - Phone:305-282-3883
Mailing Address - Fax:
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:MEMORIAL BEHAVIORAL HEALTH
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-399-6353
Practice Address - Fax:904-399-6354
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT700242084P0800X
FLME634492084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2503247-00Medicaid
FLG36335Medicare UPIN
FL27054Medicare ID - Type Unspecified