Provider Demographics
NPI:1992759641
Name:WILLIAMS, JOHNNY W (MD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:W
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1029 MEDICAL CENTER CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-251-4545
Mailing Address - Fax:270-251-4546
Practice Address - Street 1:1029 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1177
Practice Address - Country:US
Practice Address - Phone:270-251-4545
Practice Address - Fax:270-251-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY27423207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64274236Medicaid
KY000000207063OtherANTHEM
KYE58877Medicare UPIN
KY64274236Medicaid