Provider Demographics
NPI:1750453858
Name:WILLIAMS, CAROL CALHOUN (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:CALHOUN
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:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-0487
Mailing Address - Country:US
Mailing Address - Phone:217-784-4220
Mailing Address - Fax:217-784-4240
Practice Address - Street 1:124 E 8TH ST
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1455
Practice Address - Country:US
Practice Address - Phone:217-784-4220
Practice Address - Fax:217-784-4240
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL003-036087789204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL79927OtherCARLE CLINIC
IL080054331OtherRAILROAD MEDICARE
IL036087789Medicaid
IL008184OtherHAMP
IL334 680Medicare ID - Type Unspecified
IL080054331OtherRAILROAD MEDICARE