Provider Demographics
NPI:1366544827
Name:WILLIAMS, WAYNE E (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 MEDICAL CENTER CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1189
Mailing Address - Country:US
Mailing Address - Phone:270-247-7795
Mailing Address - Fax:800-574-6540
Practice Address - Street 1:1029 MEDICAL CENTER CIR STE 202
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1189
Practice Address - Country:US
Practice Address - Phone:270-247-7795
Practice Address - Fax:270-251-4551
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK348400OtherMEDICARE PTAN
KY64213713Medicaid
KY64213713Medicaid
KY000000047461OtherBLUE CROSS BLUE SHIELD
KYC74127Medicare UPIN