Provider Demographics
NPI:1306444914
Name:WILLIAMS, ANDRE BRANDON
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:BRANDON
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 1:117D WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3413
Mailing Address - Country:US
Mailing Address - Phone:304-919-6616
Mailing Address - Fax:
Practice Address - Street 1:117D WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3413
Practice Address - Country:US
Practice Address - Phone:304-919-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant