Provider Demographics
NPI:1679035430
Name:WILLIAMS, STEPHANIE L (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SCHNECK PRIMARY CARE JACKSON PARK
Mailing Address - Street 2:1124 MEDICAL PLACE
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274
Mailing Address - Country:US
Mailing Address - Phone:812-522-1613
Mailing Address - Fax:812-522-6694
Practice Address - Street 1:SCHNECK PRIMARY CARE JACKSON PARK
Practice Address - Street 2:1124 MEDICAL PLACE
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274
Practice Address - Country:US
Practice Address - Phone:812-522-1613
Practice Address - Fax:812-522-6694
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006278A207Q00000X
IN11020654A390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program