Provider Demographics
NPI:1447664545
Name:WILLIAMS, ANDREA RENEE (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5374 ROB ROY RD
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:KY
Mailing Address - Zip Code:42333-9738
Mailing Address - Country:US
Mailing Address - Phone:270-256-1811
Mailing Address - Fax:
Practice Address - Street 1:900 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1644
Practice Address - Country:US
Practice Address - Phone:270-825-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.012921207P00000X
KY04266207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY71005466870Medicaid
OH0243554Medicaid