Provider Demographics
NPI:1922055284
Name:WILLIAMS, DANIEL BLAINE (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BLAINE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:B
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2147 RIVERCHASE OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1836
Mailing Address - Country:US
Mailing Address - Phone:205-403-8902
Mailing Address - Fax:205-982-0278
Practice Address - Street 1:1848 CRESTWOOD BLVD
Practice Address - Street 2:AMERICAN FAMILY CARE INC
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210
Practice Address - Country:US
Practice Address - Phone:205-956-9192
Practice Address - Fax:205-956-3630
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51528006OtherBLUE CROSS BLUE SHIELD
AL9934302Medicaid
A06024Medicare UPIN