Provider Demographics
NPI:1598255598
Name:WILLIAMS, MATTHEW ANTHONY (RN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 TOWNSHIP ROAD 276 N
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8936
Mailing Address - Country:US
Mailing Address - Phone:304-942-5178
Mailing Address - Fax:
Practice Address - Street 1:746 TOWNSHIP ROAD 276 N
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-8936
Practice Address - Country:US
Practice Address - Phone:304-942-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.449776163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health