Provider Demographics
NPI:1952100620
Name:WILLIAMS, TOMMIE
Entity type:Individual
Prefix:
First Name:TOMMIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6971 HUMMOCK POND
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7120
Mailing Address - Country:US
Mailing Address - Phone:440-488-9490
Mailing Address - Fax:
Practice Address - Street 1:6971 HUMMOCK POND
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7120
Practice Address - Country:US
Practice Address - Phone:440-488-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health