Provider Demographics
NPI:1780456608
Name:WILLIAMS, ANDREA LEE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
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 1:5 REMINGTON CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8274
Mailing Address - Country:US
Mailing Address - Phone:501-850-8788
Mailing Address - Fax:501-850-8791
Practice Address - Street 1:3214 WINCHESTER
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2929
Practice Address - Country:US
Practice Address - Phone:501-794-6482
Practice Address - Fax:501-794-6483
Is Sole Proprietor?:No
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist