Provider Demographics
NPI:1992759641
Name:WILLIAMS, JOHNNY W (MD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:W
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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 83
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1833
Mailing Address - Country:US
Mailing Address - Phone:270-356-1138
Mailing Address - Fax:270-356-1139
Practice Address - Street 1:214 N 9TH STREET
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1833
Practice Address - Country:US
Practice Address - Phone:270-356-1138
Practice Address - Fax:270-356-1139
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27423207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000207063OtherANTHEM
KY64274236Medicaid
KYE58877Medicare UPIN
KY64274236Medicaid