Provider Demographics
NPI:1518235795
Name:WILLIAMS, COREY E
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:E
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 1:1709 WIGGLESWORTH WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2114
Mailing Address - Country:US
Mailing Address - Phone:571-314-5660
Mailing Address - Fax:
Practice Address - Street 1:1709 WIGGLESWORTH WAY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2114
Practice Address - Country:US
Practice Address - Phone:571-314-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide