Provider Demographics
NPI:1740236504
Name:WILLIAMS, REATHA M (DO)
Entity Type:Individual
Prefix:DR
First Name:REATHA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0011
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:5000 AMBASSADOR CAFFERY PKWY BLDG 10
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6984
Practice Address - Country:US
Practice Address - Phone:337-470-7801
Practice Address - Fax:337-470-7800
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8472208600000X
LADO.000148208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1369357Medicaid
FL264585801Medicaid
LA1369357Medicaid
LA4N437DB78Medicare PIN
FL264585801Medicaid