Provider Demographics
NPI:1003176447
Name:WILLIAMS, CHARLES WENDELL
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WENDELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 MANOR TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-4102
Mailing Address - Country:US
Mailing Address - Phone:832-449-3217
Mailing Address - Fax:832-449-3217
Practice Address - Street 1:6902 MANOR TERRACE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4102
Practice Address - Country:US
Practice Address - Phone:832-449-3271
Practice Address - Fax:832-449-3271
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX372600000X372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion