Provider Demographics
NPI:1487947529
Name:WILLIAMS, DELMER D
Entity type:Individual
Prefix:MR
First Name:DELMER
Middle Name:D
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 1:1610 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-3639
Mailing Address - Country:US
Mailing Address - Phone:501-749-9277
Mailing Address - Fax:501-218-8712
Practice Address - Street 1:1610 S GRANT ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-3639
Practice Address - Country:US
Practice Address - Phone:501-749-9277
Practice Address - Fax:501-218-8712
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X, 222Q00000X
AR902998289172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver