Provider Demographics
NPI:1871358408
Name:WILLIAMS, TAYLOR CECELIA (RD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CECELIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1490
Mailing Address - Country:US
Mailing Address - Phone:828-262-3886
Mailing Address - Fax:833-665-5329
Practice Address - Street 1:110 DUTCHMAN CT
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2237
Practice Address - Country:US
Practice Address - Phone:336-835-7337
Practice Address - Fax:336-835-7301
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007741133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered