Provider Demographics
NPI:1912975590
Name:WILLIAMS, GWEN (MD)
Entity Type:Individual
Prefix:
First Name:GWEN
Middle Name:
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 1:48 MEDICAL PARK E DR
Mailing Address - Street 2:STE 255
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3090
Mailing Address - Fax:205-836-2954
Practice Address - Street 1:48 MEDICAL PARK E DR
Practice Address - Street 2:STE 255
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3090
Practice Address - Fax:205-836-2954
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13251207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E11680Medicare UPIN
000081384Medicare PIN