Provider Demographics
NPI:1811044258
Name:WILLIAMS, HOMER ELBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:HOMER
Middle Name:ELBERT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 E TOWN ST
Mailing Address - Street 2:SUITE 229
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4741
Mailing Address - Country:US
Mailing Address - Phone:614-224-4566
Mailing Address - Fax:
Practice Address - Street 1:393 E TOWN ST
Practice Address - Street 2:SUITE 229
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4741
Practice Address - Country:US
Practice Address - Phone:614-224-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-02-1287-W174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9495256Medicaid
OH0109911Medicare PIN
OH9495256Medicaid