Provider Demographics
NPI:1235891862
Name:WILLIAMS, DOUGLAS JOSEPH (ATS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32519 DUNFORD ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2727
Mailing Address - Country:US
Mailing Address - Phone:248-880-0427
Mailing Address - Fax:
Practice Address - Street 1:32519 DUNFORD ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2727
Practice Address - Country:US
Practice Address - Phone:248-880-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4521494419542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty