Provider Demographics
NPI:1255604963
Name:WILLIAMS, REGINALD D SR (CSA)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:D
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PINEVALE CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-7987
Mailing Address - Country:US
Mailing Address - Phone:770-969-8363
Mailing Address - Fax:
Practice Address - Street 1:440 PINEVALE CT
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-7987
Practice Address - Country:US
Practice Address - Phone:770-969-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist