Provider Demographics
NPI:1073823522
Name:KELCEY L. WILLIAMS, MD, PLLC
Entity type:Organization
Organization Name:KELCEY L. WILLIAMS, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RENDERING PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELCEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-363-5779
Mailing Address - Street 1:104 APPLE AVE
Mailing Address - Street 2:STE 3 #114
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-1291
Mailing Address - Country:US
Mailing Address - Phone:817-284-9850
Mailing Address - Fax:949-222-4454
Practice Address - Street 1:1736 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3040
Practice Address - Country:US
Practice Address - Phone:334-712-6333
Practice Address - Fax:334-793-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7926208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB117522Medicare PIN