Provider Demographics
NPI:1649665589
Name:WILLIAMS, DEBRA ANN I
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:I
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 1:1151 OAK PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6913
Mailing Address - Country:US
Mailing Address - Phone:931-206-5322
Mailing Address - Fax:931-603-6094
Practice Address - Street 1:1151 OAK PLAINS RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6913
Practice Address - Country:US
Practice Address - Phone:931-206-5322
Practice Address - Fax:931-603-6094
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN097203245347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle