Provider Demographics
NPI:1518018365
Name:DR. HOLLY H. WILLIAMS, D.O. P.A.
Entity Type:Organization
Organization Name:DR. HOLLY H. WILLIAMS, D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-677-9174
Mailing Address - Street 1:7410 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-4333
Mailing Address - Country:US
Mailing Address - Phone:813-677-9174
Mailing Address - Fax:
Practice Address - Street 1:7410 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-4333
Practice Address - Country:US
Practice Address - Phone:813-677-9174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054886300Medicaid
FLE53016Medicare UPIN
FL054886300Medicaid