Provider Demographics
NPI:1912934241
Name:ELLA M WILLIAMS, MD PA
Entity Type:Organization
Organization Name:ELLA M WILLIAMS, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-293-9910
Mailing Address - Street 1:11797 SOUTH FWY
Mailing Address - Street 2:SUITE 226
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7026
Mailing Address - Country:US
Mailing Address - Phone:817-293-9910
Mailing Address - Fax:817-293-9911
Practice Address - Street 1:11797 SOUTH FWY
Practice Address - Street 2:SUITE 226
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7026
Practice Address - Country:US
Practice Address - Phone:817-293-9910
Practice Address - Fax:817-293-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK23852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156304101Medicaid
TX00579UOtherMEDICARE