Provider Demographics
NPI:1164046074
Name:WILLIAMS, EDMOND JR
Entity Type:Individual
Prefix:MR
First Name:EDMOND
Middle Name:
Last Name:WILLIAMS
Suffix:JR
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 1:5130 N 25TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74126-6643
Mailing Address - Country:US
Mailing Address - Phone:918-402-5435
Mailing Address - Fax:
Practice Address - Street 1:6216 S LEWIS AVE STE 103
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1017
Practice Address - Country:US
Practice Address - Phone:918-208-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management