Provider Demographics
NPI:1114620309
Name:WILLIAMS, RONNIE
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:
Last Name:WILLIAMS
Suffix:
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 1:2634 SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-2570
Mailing Address - Country:US
Mailing Address - Phone:904-525-5283
Mailing Address - Fax:
Practice Address - Street 1:2634 SANDRA LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-2570
Practice Address - Country:US
Practice Address - Phone:904-525-5283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No251E00000XAgenciesHome Health