Provider Demographics
NPI:1831799493
Name:WILLIAMS, TEAKEYA LASHAY
Entity type:Individual
Prefix:
First Name:TEAKEYA
Middle Name:LASHAY
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 1:111 DANYA CT
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-6256
Mailing Address - Country:US
Mailing Address - Phone:323-422-3471
Mailing Address - Fax:
Practice Address - Street 1:111 DANYA CT
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-6256
Practice Address - Country:US
Practice Address - Phone:323-422-3471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7669064172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver