Provider Demographics
NPI:1962042465
Name:CHILDERS, WILLIAM ALBERT JR
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALBERT
Last Name:CHILDERS
Suffix:JR
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 1:1455 W. 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52802
Mailing Address - Country:US
Mailing Address - Phone:563-200-6710
Mailing Address - Fax:
Practice Address - Street 1:1455 W. 8TH ST.
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802
Practice Address - Country:US
Practice Address - Phone:563-200-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider