Provider Demographics
NPI:1942408430
Name:TAMI O WILLIAMS MD LLC
Entity Type:Organization
Organization Name:TAMI O WILLIAMS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-334-0515
Mailing Address - Street 1:PO BOX 2076
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-2076
Mailing Address - Country:US
Mailing Address - Phone:573-334-0515
Mailing Address - Fax:573-334-1120
Practice Address - Street 1:3262 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-2609
Practice Address - Country:US
Practice Address - Phone:573-334-0515
Practice Address - Fax:573-334-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000156016207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1863120OtherCOVENTRY FIRST HEALTH
MO434499OtherHEALTHLINK PROVIDER #
MO128569OtherBLUE CROSS PROVIDER #
MO1863120OtherCOVENTRY FIRST HEALTH