Provider Demographics
NPI:1376181578
Name:WILLIAMS, TASHIKA T
Entity Type:Individual
Prefix:
First Name:TASHIKA
Middle Name:T
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 1:1024 N DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-1508
Mailing Address - Country:US
Mailing Address - Phone:217-330-0672
Mailing Address - Fax:
Practice Address - Street 1:1024 N DUNHAM AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-1508
Practice Address - Country:US
Practice Address - Phone:217-330-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health