Provider Demographics
NPI:1770546004
Name:WILLIAMS, MELBORNE A (MD)
Entity type:Individual
Prefix:DR
First Name:MELBORNE
Middle Name:A
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:P.O. BOX 2028
Mailing Address - Street 2:416 WEST WALNUT ST.
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422
Mailing Address - Country:US
Mailing Address - Phone:859-236-7300
Mailing Address - Fax:859-236-6600
Practice Address - Street 1:122 DANIEL DRIVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-7300
Practice Address - Fax:859-236-6600
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY170712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64170715Medicaid
KYB03370Medicare UPIN
KY64170715Medicaid