Provider Demographics
NPI:1467743534
Name:WILLIAMS, CARLOS (BA, BHRS)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BA, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7801
Mailing Address - Country:US
Mailing Address - Phone:405-837-1065
Mailing Address - Fax:
Practice Address - Street 1:12205 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7801
Practice Address - Country:US
Practice Address - Phone:405-837-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
OKL081688491171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractor