Provider Demographics
NPI:1720705924
Name:GUILLIAMS, TIMOTHY THOMAS
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:THOMAS
Last Name:GUILLIAMS
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 1:1245 VINE ST
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2450
Mailing Address - Country:US
Mailing Address - Phone:740-575-3134
Mailing Address - Fax:
Practice Address - Street 1:85 PINE ST APT 211
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1937
Practice Address - Country:US
Practice Address - Phone:740-295-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide