Provider Demographics
NPI:1801530316
Name:WILLIAMS, ANNISE BILLY JR
Entity type:Individual
Prefix:
First Name:ANNISE
Middle Name:BILLY
Last Name:WILLIAMS
Suffix:JR
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 1:2235 LAKE AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2491
Mailing Address - Country:US
Mailing Address - Phone:626-797-9196
Mailing Address - Fax:
Practice Address - Street 1:2235 LAKE AVE STE 211
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2491
Practice Address - Country:US
Practice Address - Phone:626-797-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty