Provider Demographics
NPI:1437754967
Name:WILLIAMS, TOMMY JR (INC)
Entity Type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 BAY RD
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-9530
Mailing Address - Country:US
Mailing Address - Phone:910-441-5415
Mailing Address - Fax:
Practice Address - Street 1:1439 BAY RD
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-9530
Practice Address - Country:US
Practice Address - Phone:910-441-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children