Provider Demographics
NPI:1689103434
Name:WILLIAMS, GWENDOLYN ANN
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ANN
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 1:8913 SHARON HILLS ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-2356
Mailing Address - Country:US
Mailing Address - Phone:225-270-9532
Mailing Address - Fax:225-356-3392
Practice Address - Street 1:8913 SHARON HILLS ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-2356
Practice Address - Country:US
Practice Address - Phone:225-270-9532
Practice Address - Fax:225-356-3392
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker