Provider Demographics
NPI:1487019337
Name:WILLIAMS, GERETTA
Entity Type:Individual
Prefix:
First Name:GERETTA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17127 DEATON MILL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5530
Mailing Address - Country:US
Mailing Address - Phone:832-312-4228
Mailing Address - Fax:
Practice Address - Street 1:17127 DEATON MILL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5530
Practice Address - Country:US
Practice Address - Phone:832-312-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-19
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center