Provider Demographics
NPI:1407666753
Name:PRIVETTE, WILLIAM ANTRIWAN
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ANTRIWAN
Last Name:PRIVETTE
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 1:10926 QUALITY DR UNIT 38957
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8873
Mailing Address - Country:US
Mailing Address - Phone:980-226-8759
Mailing Address - Fax:
Practice Address - Street 1:12025 FRESHWELL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6743
Practice Address - Country:US
Practice Address - Phone:980-226-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)