Provider Demographics
NPI:1003627068
Name:WILLIAMS, DOMINIQUE DARRELL
Entity type:Individual
Prefix:MR
First Name:DOMINIQUE
Middle Name:DARRELL
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 1:13913 WOODWORTH RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1919
Mailing Address - Country:US
Mailing Address - Phone:216-965-6736
Mailing Address - Fax:
Practice Address - Street 1:13913 WOODWORTH RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1919
Practice Address - Country:US
Practice Address - Phone:216-965-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTH234223251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health