Provider Demographics
NPI:1609195445
Name:WILLIAMS, PRISCILLA DENISE (OWNER)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 S FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3162
Mailing Address - Country:US
Mailing Address - Phone:937-460-8871
Mailing Address - Fax:937-717-9192
Practice Address - Street 1:1552 S FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-3162
Practice Address - Country:US
Practice Address - Phone:937-460-8871
Practice Address - Fax:937-717-9192
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health