Provider Demographics
NPI:1760250765
Name:WILLIAMS, AIREAL (RD)
Entity Type:Individual
Prefix:
First Name:AIREAL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 GARBER CT APT A
Mailing Address - Street 2:
Mailing Address - City:FORT JOHNSON
Mailing Address - State:LA
Mailing Address - Zip Code:71459-3136
Mailing Address - Country:US
Mailing Address - Phone:706-577-2162
Mailing Address - Fax:
Practice Address - Street 1:1585 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT JOHNSON
Practice Address - State:LA
Practice Address - Zip Code:71459-5102
Practice Address - Country:US
Practice Address - Phone:337-531-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered