Provider Demographics
NPI:1821478314
Name:WILLIAMS, MELVIN
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 EDSALL RD
Mailing Address - Street 2:APT 1511
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4166
Mailing Address - Country:US
Mailing Address - Phone:703-625-9197
Mailing Address - Fax:
Practice Address - Street 1:6000 STEVENSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4140
Practice Address - Country:US
Practice Address - Phone:877-987-3529
Practice Address - Fax:877-987-3529
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019003902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist