Provider Demographics
NPI:1104147669
Name:WILLIAMS, AMANDA KAY (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KAY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:55 PARK AVE
Mailing Address - Street 2:STE 275
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1170
Mailing Address - Country:US
Mailing Address - Phone:740-845-7500
Mailing Address - Fax:
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:STE 275
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1170
Practice Address - Country:US
Practice Address - Phone:740-845-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01741207QG0300X
OH34011467207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine