Provider Demographics
NPI:1841251253
Name:WILLIAMS-VAUGHN, IMANI NAJUMA (MD)
Entity type:Individual
Prefix:DR
First Name:IMANI
Middle Name:NAJUMA
Last Name:WILLIAMS-VAUGHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:IMANI
Other - Middle Name:NAJUMA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 N DOBSON RD STE 15
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4412
Mailing Address - Country:US
Mailing Address - Phone:480-282-8336
Mailing Address - Fax:480-282-8365
Practice Address - Street 1:333 N DOBSON RD STE 15
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:480-282-8336
Practice Address - Fax:480-282-8365
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7045160001332B00000X
AZ7047150001332B00000X
AZ7629170001332B00000X
AZ705360001332B00000X
AZ7034950001332B00000X
AZ32653207Q00000X
AZ7046960001332B00000X
AZ7209350001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ871229Medicaid
AZ107592Medicare PIN
AZ871229Medicaid
AZI08237Medicare UPIN
107592Medicare PIN