Carolyn McCullagh Williams, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 9101182 Issued in FL

Practice address

3871 E Highway 98 Ste 201
Port St Joe, FL 32456

Phone

(850) 229-3712

Fax

(850) 229-3712

NPI assigned

Oct 6, 2006

Last updated

Feb 15, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ascension Sacred Heart Gulf

  dba Ascension Medical Group Sacred Heart Gulf

  • Family Medicine Physician
  • Pensacola, FL
  • NPI 1528336302
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1750478129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2699",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325132699",
            "telephone_number": "850-475-4686",
            "fax_number": "850-475-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3871 E HIGHWAY 98 STE 201",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "32456",
            "telephone_number": "850-229-3712",
            "fax_number": "850-229-3712"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "419 Baltzell Ave",
            "address_purpose": "LOCATION",
            "city": "Port St Joe",
            "state": "FL",
            "postal_code": "324561864",
            "country_code": "US",
            "telephone_number": "850-229-8010",
            "fax_number": "850-227-3177",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CAROLYN",
        "middle_name": "MCCULLAGH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9101182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291229500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vincent M Ivers
• Kimberly Thomas Wagner, PT
• Regina C Washabaugh, RN
• David James Whitfield, MSPT, DPT
• Sheila E Whitfield
• Doris Evelyn Youngs, RN
• Janel Denise Zimmerman, LMSW

• Physician Assistant in Port St Joe, FL
• Providers in Port St Joe, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.