Provider Demographics
NPI:1497375364
Name:WILLIAMS III, LONNIE EUGENE
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:EUGENE
Last Name:WILLIAMS III
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 1:1331 CONGRESS ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5064
Mailing Address - Country:US
Mailing Address - Phone:202-875-9887
Mailing Address - Fax:
Practice Address - Street 1:1330 CONGRESS ST SE APT 5
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5073
Practice Address - Country:US
Practice Address - Phone:202-487-1981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant