Provider Demographics
NPI:1205625449
Name:WILLIAMS, KORI
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 W DICKENS AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3482
Mailing Address - Country:US
Mailing Address - Phone:708-400-0679
Mailing Address - Fax:
Practice Address - Street 1:523 E 154TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:IL
Practice Address - Zip Code:60426-2310
Practice Address - Country:US
Practice Address - Phone:872-348-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)