Provider Demographics
NPI:1700457017
Name:WILLIAMS, DARIUS DEMETRUS
Entity Type:Individual
Prefix:
First Name:DARIUS
Middle Name:DEMETRUS
Last Name:WILLIAMS
Suffix:
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 1:7933 NW 39TH AVE APT 123
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-0029
Mailing Address - Country:US
Mailing Address - Phone:352-871-6926
Mailing Address - Fax:
Practice Address - Street 1:3429 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2402
Practice Address - Country:US
Practice Address - Phone:352-681-4081
Practice Address - Fax:352-451-4133
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor