Provider Demographics
NPI:1467139725
Name:WILLIAMS, JOHN CALLYE JR (HIS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CALLYE
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10905
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47801-0905
Mailing Address - Country:US
Mailing Address - Phone:812-232-7500
Mailing Address - Fax:
Practice Address - Street 1:4432 S HIDDEN WAY ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-6600
Practice Address - Country:US
Practice Address - Phone:812-232-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001534A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist