Provider Demographics
NPI:1588422265
Name:WILLIAMS, CHIQUITA M
Entity type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:M
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 1:209 W 2ND ST STE 332
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-3021
Mailing Address - Country:US
Mailing Address - Phone:682-267-3858
Mailing Address - Fax:
Practice Address - Street 1:702 HOUSTON ST STE 132
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5004
Practice Address - Country:US
Practice Address - Phone:682-267-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory