Provider Demographics
NPI:1861800195
Name:WILLIAMS, AUDIE (CST/CSFA)
Entity type:Individual
Prefix:
First Name:AUDIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 W CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-7769
Mailing Address - Country:US
Mailing Address - Phone:269-444-8396
Mailing Address - Fax:
Practice Address - Street 1:438 W CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-7769
Practice Address - Country:US
Practice Address - Phone:269-444-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant