Provider Demographics
NPI:1053393785
Name:WILLIAMS, LAURA LEE (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-1222
Mailing Address - Country:US
Mailing Address - Phone:501-372-8400
Mailing Address - Fax:501-372-8401
Practice Address - Street 1:2504 MCCAIN BLVD STE 118
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7624
Practice Address - Country:US
Practice Address - Phone:501-812-6655
Practice Address - Fax:501-279-9011
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-7112208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J133OtherAR BLUE CROSS BLUE SHIELD
AR123497001Medicaid
AR1220068OtherUNITED HEALTHCARE
AR12111000000OtherQUALCHOICE
AR5J133Medicare ID - Type Unspecified
AR123497001Medicaid