Provider Demographics
NPI:1295998979
Name:WILLIAMS, NICOLE O (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:O
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-5066
Mailing Address - Fax:
Practice Address - Street 1:1145 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3117
Practice Address - Country:US
Practice Address - Phone:614-293-5066
Practice Address - Fax:614-293-9449
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096500207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0159908Medicaid
OHPENDINGMedicare PIN