Provider Demographics
NPI:1730158874
Name:WILLIAMS, N WYNTA (DPM)
Entity type:Individual
Prefix:DR
First Name:N
Middle Name:WYNTA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:N
Other - Middle Name:WYNTA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:4224 HOLLAND RD
Mailing Address - Street 2:SUITE #106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1900
Mailing Address - Country:US
Mailing Address - Phone:757-498-0202
Mailing Address - Fax:757-498-7936
Practice Address - Street 1:4224 HOLLAND RD
Practice Address - Street 2:SUITE #106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1900
Practice Address - Country:US
Practice Address - Phone:757-498-0202
Practice Address - Fax:757-498-7936
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000797213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA480032523OtherRR MEDICARE
VA5180770001OtherDMERC
VA9300953Medicaid
VA235919OtherANTHEM BLUE SHIELD BLUE C
VA45494OtherOPTIMA HEALTH
VA292614OtherMDIPA
VA5180770002OtherDMERC
VA235919OtherANTHEM BLUE SHIELD BLUE C
VA45494OtherOPTIMA HEALTH