Provider Demographics
NPI:1376286252
Name:WILLIAMS, ROBERT DONALD JR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DONALD
Last Name:WILLIAMS
Suffix:JR
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 1:3763 2ND AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2281
Mailing Address - Country:US
Mailing Address - Phone:313-208-1548
Mailing Address - Fax:
Practice Address - Street 1:3763 2ND AVE APT 4A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2281
Practice Address - Country:US
Practice Address - Phone:313-208-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide