Provider Demographics
NPI:1407816341
Name:WILLIAMS, SCOTT SHIELDS (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:SHIELDS
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6063
Mailing Address - Fax:904-539-4091
Practice Address - Street 1:5153 N 9TH AVE STE 4B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-416-2280
Practice Address - Fax:850-416-2258
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1652192080P0210X
LAMD.2032622080P0210X
AZ52243207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02822278Medicaid
AZ148504Medicaid
TX173607601Medicaid
LA1755095Medicaid
AZ148504Medicaid
MS02822278Medicaid