Provider Demographics
NPI:1457062309
Name:WILLIAMS, MARVIN R III
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:R
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 466 BOX 3
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96595-0001
Mailing Address - Country:US
Mailing Address - Phone:246-370-4256
Mailing Address - Fax:
Practice Address - Street 1:PSC 466 BX3
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96595-0001
Practice Address - Country:US
Practice Address - Phone:246-370-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman