Provider Demographics
NPI:1871315085
Name:WILLIAMS, BRITTANY DONAE
Entity type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:DONAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:CHRISTOPHER
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:637 GROVER LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8212
Mailing Address - Country:US
Mailing Address - Phone:904-458-5822
Mailing Address - Fax:
Practice Address - Street 1:637 GROVER LN
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8212
Practice Address - Country:US
Practice Address - Phone:904-458-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
FL172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver