Provider Demographics
NPI:1982159703
Name:WILLIAMS-MONTGOMERY, ANDREKIA (MA, PBT)
Entity Type:Individual
Prefix:
First Name:ANDREKIA
Middle Name:
Last Name:WILLIAMS-MONTGOMERY
Suffix:
Gender:F
Credentials:MA, PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 NW 22ND CT APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3545
Mailing Address - Country:US
Mailing Address - Phone:954-709-9849
Mailing Address - Fax:702-554-5096
Practice Address - Street 1:1471 NW 22ND CT APT 1
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-3545
Practice Address - Country:US
Practice Address - Phone:954-709-9849
Practice Address - Fax:702-554-5096
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL828224291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory