Provider Demographics
NPI:1205307766
Name:WILLIAMS, JUANITA
Entity type:Individual
Prefix:
First Name:JUANITA
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:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-1086
Mailing Address - Country:US
Mailing Address - Phone:270-900-0373
Mailing Address - Fax:270-900-0426
Practice Address - Street 1:723 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1063
Practice Address - Country:US
Practice Address - Phone:270-900-0373
Practice Address - Fax:270-900-0426
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator