Provider Demographics
NPI:1538697172
Name:WILLIAMS, SALLEY
Entity Type:Individual
Prefix:
First Name:SALLEY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 WESTERRE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1339
Mailing Address - Country:US
Mailing Address - Phone:888-605-9061
Mailing Address - Fax:615-235-9725
Practice Address - Street 1:2648 COUNTY ROAD 79
Practice Address - Street 2:
Practice Address - City:DOUBLE SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:35553-4254
Practice Address - Country:US
Practice Address - Phone:661-567-8855
Practice Address - Fax:662-377-5085
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST6VUJU363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology