Provider Demographics
NPI:1780240754
Name:WILLIAM NIELDS, PLLC
Entity type:Organization
Organization Name:WILLIAM NIELDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-923-3484
Mailing Address - Street 1:1539 PARENTAL HOME RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3009
Mailing Address - Country:US
Mailing Address - Phone:042-906-0289
Mailing Address - Fax:
Practice Address - Street 1:1539 PARENTAL HOME RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3009
Practice Address - Country:US
Practice Address - Phone:904-923-3484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty