Provider Demographics
NPI:1508982091
Name:WILLIAMS, MARCUS (CCP LP)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CCP LP
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 12815
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-2815
Mailing Address - Country:US
Mailing Address - Phone:405-604-5613
Mailing Address - Fax:405-601-3750
Practice Address - Street 1:3601 N MAY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6641
Practice Address - Country:US
Practice Address - Phone:405-604-5613
Practice Address - Fax:405-601-3750
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLP11247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other