Provider Demographics
NPI:1184981235
Name:WILLIAMS, LAMONT TERRANCE
Entity type:Individual
Prefix:
First Name:LAMONT
Middle Name:TERRANCE
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 1:5129 W VIENNA AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2312
Mailing Address - Country:US
Mailing Address - Phone:414-803-4976
Mailing Address - Fax:
Practice Address - Street 1:5129 W VIENNA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2312
Practice Address - Country:US
Practice Address - Phone:414-803-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIW452-5387-2415-07343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)