Provider Demographics
NPI:1851447130
Name:WILLIAMS, KATALLIA
Entity Type:Individual
Prefix:
First Name:KATALLIA
Middle Name:
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 1:10118 NW 33RD PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6941
Mailing Address - Country:US
Mailing Address - Phone:954-747-9872
Mailing Address - Fax:954-747-9872
Practice Address - Street 1:10118 NW 33RD PL
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6941
Practice Address - Country:US
Practice Address - Phone:954-747-9872
Practice Address - Fax:954-747-9872
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 47403171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor