Provider Demographics
NPI:1417588211
Name:WILLIAMS, HARRY D
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:D
Last Name:WILLIAMS
Suffix:
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 1:1026 GALLANT FOX CIR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1955
Mailing Address - Country:US
Mailing Address - Phone:904-476-8538
Mailing Address - Fax:
Practice Address - Street 1:1026 GALLANT FOX CIR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-1955
Practice Address - Country:US
Practice Address - Phone:904-476-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker