Provider Demographics
NPI:1053534479
Name:WILLIAMS, TANEKA M (MD)
Entity type:Individual
Prefix:MS
First Name:TANEKA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:24420 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-9600
Mailing Address - Country:US
Mailing Address - Phone:910-369-3136
Mailing Address - Fax:910-369-4756
Practice Address - Street 1:24420 MARLBORO ST
Practice Address - Street 2:
Practice Address - City:WAGRAM
Practice Address - State:NC
Practice Address - Zip Code:28396-9600
Practice Address - Country:US
Practice Address - Phone:910-369-3136
Practice Address - Fax:910-369-4756
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1461NOtherBCBSNC
NC5908157Medicaid
NC5908157Medicaid