1699014076 NPI number — AMELIA P. WILLIAMS

Table of content: (NPI 1699014076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699014076 NPI number — AMELIA P. WILLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMELIA P. WILLIAMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1699014076
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
349 TECHNICAL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-2873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-264-5332
Provider Business Mailing Address Fax Number:
188-831-6369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
349 TECHNICAL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-2873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-264-5332
Provider Business Practice Location Address Fax Number:
188-831-6369
Provider Enumeration Date:
02/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
AMELIA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
919-264-5332

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  5053 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 102L00000X , with the licence number: 151803 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 5053 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5916159 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008274 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6104973 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6102867 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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