1447291778 NPI number — LOLA KATHLEEN WILLIAMS CRNP

Table of content: LOLA KATHLEEN WILLIAMS CRNP (NPI 1447291778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447291778 NPI number — LOLA KATHLEEN WILLIAMS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LOLA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMAS
Provider Other First Name:
LOLA
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447291778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2400
Provider Second Line Business Mailing Address:
1220 MAIN DRIVE
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35403-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-349-3250
Provider Business Mailing Address Fax Number:
205-345-3993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10290 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKMAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35579-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-622-2830
Provider Business Practice Location Address Fax Number:
205-622-2673
Provider Enumeration Date:
06/09/2006

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:  1051448 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109150 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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