Provider Demographics
NPI:1942511126
Name:WILLIAMS, AMANDA LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:721 KENMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2306
Mailing Address - Country:US
Mailing Address - Phone:616-949-6112
Mailing Address - Fax:616-949-8530
Practice Address - Street 1:721 KENMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2306
Practice Address - Country:US
Practice Address - Phone:616-949-6112
Practice Address - Fax:616-949-8530
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60686208000000X
MI4301097118208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics