Provider Demographics
NPI:1700503372
Name:WILLIAMS, ROBERT EARL
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
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 1:2260 COTTINGTON ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5727
Mailing Address - Country:US
Mailing Address - Phone:330-936-7692
Mailing Address - Fax:
Practice Address - Street 1:2260 COTTINGTON ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5727
Practice Address - Country:US
Practice Address - Phone:330-936-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)