Provider Demographics
NPI:1346807856
Name:WILLIAMS, JATAUN MARIE
Entity Type:Individual
Prefix:
First Name:JATAUN
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 AINTREE PARK DR APT 203
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3547
Mailing Address - Country:US
Mailing Address - Phone:216-765-2776
Mailing Address - Fax:
Practice Address - Street 1:943 AINTREE PARK DR APT 203
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3547
Practice Address - Country:US
Practice Address - Phone:216-765-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty