Provider Demographics
NPI:1235823527
Name:WILLIAMS, ALVIN T
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:T
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 1:803 BRISCO AVE
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5161
Mailing Address - Country:US
Mailing Address - Phone:318-974-6035
Mailing Address - Fax:318-974-6035
Practice Address - Street 1:803 BRISCO AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5161
Practice Address - Country:US
Practice Address - Phone:318-974-6035
Practice Address - Fax:318-974-6035
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LABH0012507171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator