Provider Demographics
NPI:1558505800
Name:LARSON-WILLIAMS, LINNEA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:MICHELLE
Last Name:LARSON-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:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-1775
Mailing Address - Fax:256-265-1780
Practice Address - Street 1:401 LOWELL DR SE
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3748
Practice Address - Country:US
Practice Address - Phone:256-265-1775
Practice Address - Fax:256-265-1780
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30518208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL137473Medicaid
AL137898Medicaid