Provider Demographics
NPI:1659692440
Name:WILLIAMS, PRINCESS NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:PRINCESS
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRINCESS
Other - Middle Name:NICOLE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 FAIRVIEW RD
Mailing Address - Street 2:STE 110
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9506
Mailing Address - Country:US
Mailing Address - Phone:205-930-0806
Mailing Address - Fax:
Practice Address - Street 1:150 FAIRVIEW RD
Practice Address - Street 2:STE 110
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9506
Practice Address - Country:US
Practice Address - Phone:704-769-3800
Practice Address - Fax:704-800-6006
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL350242086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL35024OtherALBME