Provider Demographics
NPI:1013971142
Name:WILLIAMS, DONNETTE FELICE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNETTE
Middle Name:FELICE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOSPITAL DR STE 290
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2455
Mailing Address - Country:US
Mailing Address - Phone:386-317-8640
Mailing Address - Fax:386-317-8645
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:SUITE 290
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2452
Practice Address - Country:US
Practice Address - Phone:386-437-7977
Practice Address - Fax:386-437-7732
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31859WOtherMEDICARE ID - TYPE UNSPECIFIED
FL254912300Medicaid
FLB49428Medicare UPIN
FL31859WOtherMEDICARE ID - TYPE UNSPECIFIED