Provider Demographics
NPI:1912596420
Name:WILLIAMS, LEE ANDREW I
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:ANDREW
Last Name:WILLIAMS
Suffix:I
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 1:1955 SAN PABLO AVE APT 214A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1394
Mailing Address - Country:US
Mailing Address - Phone:510-692-1961
Mailing Address - Fax:
Practice Address - Street 1:1955 SAN PABLO AVE APT 214A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1394
Practice Address - Country:US
Practice Address - Phone:510-692-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program