1326390071 NPI number — ELIZABETH A WILLIAMS NP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326390071 NPI number — ELIZABETH A WILLIAMS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
ELIZABETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAVERS
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326390071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 MEDICAL PARK DR
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24354-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-378-1341
Provider Business Mailing Address Fax Number:
276-378-1205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24354-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-378-1341
Provider Business Practice Location Address Fax Number:
276-378-1205
Provider Enumeration Date:
10/04/2012

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: 363LF0000X , with the licence number:  0024170318 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q013548 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326390071 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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