Provider Demographics
NPI:1386105419
Name:WILLIAMS, JOYCE G
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WILLIAMS TRL
Mailing Address - Street 2:
Mailing Address - City:PLAIN DEALING
Mailing Address - State:LA
Mailing Address - Zip Code:71064-4238
Mailing Address - Country:US
Mailing Address - Phone:318-840-7446
Mailing Address - Fax:
Practice Address - Street 1:154 WILLIAMS TRL
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064-4238
Practice Address - Country:US
Practice Address - Phone:318-840-7446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier