Provider Demographics
NPI:1124813613
Name:WILLIAMS, DONALD JR
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:WILLIAMS
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5293 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7723
Mailing Address - Country:US
Mailing Address - Phone:513-800-5638
Mailing Address - Fax:
Practice Address - Street 1:4843 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4456
Practice Address - Country:US
Practice Address - Phone:513-800-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRU323853172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver