Provider Demographics
NPI:1053659672
Name:WILLIAMS, LACY HOLMES
Entity Type:Individual
Prefix:DR
First Name:LACY
Middle Name:HOLMES
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 1:416 TRAVIS ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-3282
Mailing Address - Country:US
Mailing Address - Phone:318-222-7464
Mailing Address - Fax:318-222-7466
Practice Address - Street 1:416 TRAVIS ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3282
Practice Address - Country:US
Practice Address - Phone:318-222-7464
Practice Address - Fax:318-222-7466
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD11112085R0202X
LAMD02843R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology