Provider Demographics
NPI:1205687829
Name:WILLIAMS, AUNDREA
Entity type:Individual
Prefix:
First Name:AUNDREA
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 1:2829 HOLLY GLEN DR APT A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-0099
Mailing Address - Country:US
Mailing Address - Phone:252-258-5005
Mailing Address - Fax:
Practice Address - Street 1:2829 HOLLY GLEN DR APT A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-0099
Practice Address - Country:US
Practice Address - Phone:252-258-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000028518045172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver