Provider Demographics
NPI:1457848053
Name:WILLIAMS, JOHNNY LEE II
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:LEE
Last Name:WILLIAMS
Suffix:II
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 1:8400 E YALE AVE APT 3-201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3853
Mailing Address - Country:US
Mailing Address - Phone:405-550-9968
Mailing Address - Fax:
Practice Address - Street 1:2625 S COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-5910
Practice Address - Country:US
Practice Address - Phone:720-390-9459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator