Provider Demographics
NPI:1811368152
Name:WILLIAMS, ANGELA (HAIRLOSS SPECIALIST)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HAIRLOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 BRONCO CROSSING TRL
Mailing Address - Street 2:# 814
Mailing Address - City:FORT WORTH
Mailing Address - State:TEXAS
Mailing Address - Zip Code:76123
Mailing Address - Country:UM
Mailing Address - Phone:844-305-4247
Mailing Address - Fax:
Practice Address - Street 1:4101 S COOPER ST STE 115
Practice Address - Street 2:SUITE 7
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4142
Practice Address - Country:US
Practice Address - Phone:844-305-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9914991744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management