Provider Demographics
NPI:1912953324
Name:WILLIAMS, ERICA D (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:2400 EASTPOINT PKWY
Practice Address - Street 2:SUITE 450
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4154
Practice Address - Country:US
Practice Address - Phone:502-244-6899
Practice Address - Fax:502-244-6940
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY38078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64083900Medicaid
KY64083900Medicaid
KYP00142094Medicare PIN
KY00546115Medicare Oscar/Certification