Taneka M Williams, M.D.
Individual provider Active NPI Family Medicine Physician · Wagram, NC
NPI 1053534479 · NPPES record last updated Jul 24, 2014
Key facts
- NPI
- 1053534479
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 2006-01917 (NC)
- Practice address
- 24420 Marlboro St
Wagram, NC 28396-9600 - Phone
- (910) 369-3136
- Fax
- (910) 369-4756
- NPI assigned
- Apr 11, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071029000174 | NC | Practitioner - Family Practice |
7416044151 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vohra Wound Physicians of Ny, PLLC | Family Medicine | Current |
Accepting new patients |
Locations
717 Green Valley Rd
Ste 200
Greensboro, NC 27408
Phone (336) 444-6894
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2006-01917 | NC | Yes |
Addresses
Primary practice location
24420 Marlboro St
Wagram, NC 28396-9600
Mailing address
24420 Marlboro St
Wagram, NC 28396-9600
Phone (910) 369-3136
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1461N | Other | NC | BCBSNC |
| 5908157 | Medicaid | NC |
Other providers in Wagram, NC
All providers in Wagram, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.