Provider Demographics
NPI:1346587771
Name:ODIES H. WILLIAMS, III, M. D., P. C.
Entity Type:Organization
Organization Name:ODIES H. WILLIAMS, III, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ODIES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:219-949-3203
Mailing Address - Street 1:2200 GRANT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3439
Mailing Address - Country:US
Mailing Address - Phone:219-949-3203
Mailing Address - Fax:219-944-7030
Practice Address - Street 1:2200 GRANT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3439
Practice Address - Country:US
Practice Address - Phone:219-949-3203
Practice Address - Fax:219-944-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026836A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty