Provider Demographics
NPI:1194244608
Name:WILLIAMS, DENISE (HOMEMAKER PROVIDER)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HOMEMAKER PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WREN DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-7226
Mailing Address - Country:US
Mailing Address - Phone:662-453-4047
Mailing Address - Fax:
Practice Address - Street 1:16979 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-6468
Practice Address - Country:US
Practice Address - Phone:662-458-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty