Provider Demographics
NPI:1598253221
Name:WILLIAMS, DE-VAUGHN
Entity Type:Individual
Prefix:
First Name:DE-VAUGHN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 SW ARCHER RD APT 160
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1318
Mailing Address - Country:US
Mailing Address - Phone:561-809-3530
Mailing Address - Fax:
Practice Address - Street 1:102 MASON FARM RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-6134
Practice Address - Country:US
Practice Address - Phone:919-966-1459
Practice Address - Fax:919-843-2356
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-01420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine