Provider Demographics
NPI:1962500876
Name:WILLIAMS, VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1047
Mailing Address - Country:US
Mailing Address - Phone:614-725-1901
Mailing Address - Fax:614-725-1904
Practice Address - Street 1:1460 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1047
Practice Address - Country:US
Practice Address - Phone:614-445-7755
Practice Address - Fax:614-445-7238
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21386207Q00000X
OH35.076195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH02823Medicare UPIN