Provider Demographics
NPI:1356022859
Name:WILLIAMS, TAWANA
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAWANA
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4979 ASTONSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8746
Mailing Address - Country:US
Mailing Address - Phone:980-358-7375
Mailing Address - Fax:
Practice Address - Street 1:4979 ASTONSHIRE LN
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8746
Practice Address - Country:US
Practice Address - Phone:980-358-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker