Provider Demographics
NPI:1477013084
Name:WILLIAMS, ERIC D
Entity Type:Individual
Prefix:
First Name:ERIC
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 1:4659 HIGHWAY 546
Mailing Address - Street 2:
Mailing Address - City:EROS
Mailing Address - State:LA
Mailing Address - Zip Code:71238-8353
Mailing Address - Country:US
Mailing Address - Phone:318-512-5011
Mailing Address - Fax:
Practice Address - Street 1:1012 BENNIE BREECE ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71292-5914
Practice Address - Country:US
Practice Address - Phone:318-512-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver