Provider Demographics
NPI:1558576801
Name:WILLIAMS, GINNY LANELL
Entity Type:Individual
Prefix:MS
First Name:GINNY
Middle Name:LANELL
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 1:18414 S HWY 75
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-4711
Mailing Address - Country:US
Mailing Address - Phone:918-827-3106
Mailing Address - Fax:
Practice Address - Street 1:18414 S HWY 75
Practice Address - Street 2:
Practice Address - City:MOUNDS
Practice Address - State:OK
Practice Address - Zip Code:74047-4711
Practice Address - Country:US
Practice Address - Phone:918-827-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200024480-A174400000X
OK200024480B174400000X
OK200024480C174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist