Provider Demographics
NPI:1285394056
Name:WILLIAMS, CHESTER BRUCE
Entity type:Individual
Prefix:MR
First Name:CHESTER
Middle Name:BRUCE
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 1:362 WILLIAMS SCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27823-8505
Mailing Address - Country:US
Mailing Address - Phone:252-673-5080
Mailing Address - Fax:
Practice Address - Street 1:6878 OLD 125 RD
Practice Address - Street 2:
Practice Address - City:SCOTLAND NECK
Practice Address - State:NC
Practice Address - Zip Code:27874-8963
Practice Address - Country:US
Practice Address - Phone:252-673-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker