Provider Demographics
NPI:1215064134
Name:WILLIAMS, TERRIE S (MD)
Entity type:Individual
Prefix:DR
First Name:TERRIE
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 US HIGHWAY 42
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6349
Mailing Address - Country:US
Mailing Address - Phone:502-426-9565
Mailing Address - Fax:502-425-3240
Practice Address - Street 1:4912 US HIGHWAY 42
Practice Address - Street 2:SUITE 208
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-6349
Practice Address - Country:US
Practice Address - Phone:502-426-9565
Practice Address - Fax:502-425-3240
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24086207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4221695OtherAETNA
KY2528449OtherCIGNA
KYKO11398OtherTRICARE STANDARD
KY000000049884OtherANTHEM
KY64240864Medicaid
KYE35109Medicare UPIN
KY0251802Medicare ID - Type Unspecified