Provider Demographics
NPI:1306073655
Name:WILLIAMS, ANNIE NOELLE (DO)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:NOELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15420 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6339
Mailing Address - Country:US
Mailing Address - Phone:586-226-7007
Mailing Address - Fax:586-226-7033
Practice Address - Street 1:15420 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6339
Practice Address - Country:US
Practice Address - Phone:586-226-7007
Practice Address - Fax:586-226-7033
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010182252084P0800X, 2084P0804X
MI53150411422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry