1093850257 NPI number — DR. THOMAS FRANKLIN WILLIAMS JR. PHD

Table of content: DR. THOMAS FRANKLIN WILLIAMS JR. PHD (NPI 1093850257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093850257 NPI number — DR. THOMAS FRANKLIN WILLIAMS JR. PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
THOMAS
Provider Middle Name:
FRANKLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093850257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1895 KINGSLEY AVE
Provider Second Line Business Mailing Address:
S-1005
Provider Business Mailing Address City Name:
ORANGE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-298-2525
Provider Business Mailing Address Fax Number:
904-298-1515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1542 KINGSLEY AVE
Provider Second Line Business Practice Location Address:
S-141
Provider Business Practice Location Address City Name:
ORANGE PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32073-4586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-278-9828
Provider Business Practice Location Address Fax Number:
904-278-9818
Provider Enumeration Date:
02/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  FLAY1067 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: AY1067 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003911700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".