Provider Demographics
NPI:1184838393
Name:LENERT-WILLIAMS, CARMELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMELL
Middle Name:
Last Name:LENERT-WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 MANSFIELD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3155
Mailing Address - Country:US
Mailing Address - Phone:318-629-3763
Mailing Address - Fax:
Practice Address - Street 1:9300 MANSFIELD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3155
Practice Address - Country:US
Practice Address - Phone:318-629-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203095207P00000X
TXP2480207P00000X
LAMD20395174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1888389Medicaid
LA1888389Medicaid