Provider Demographics
NPI:1780982660
Name:WILLIAMS, CARTER P (CPO)
Entity type:Individual
Prefix:MR
First Name:CARTER
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 HUGUENOT RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2478
Mailing Address - Country:US
Mailing Address - Phone:804-378-4902
Mailing Address - Fax:804-378-4904
Practice Address - Street 1:1500 HUGUENOT RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2478
Practice Address - Country:US
Practice Address - Phone:804-378-4902
Practice Address - Fax:804-378-4904
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326323031Medicaid
1326323031Medicare NSC