Provider Demographics
NPI:1992476246
Name:WILLIAMS, JAMES DALTON
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DALTON
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 1:17060 DALLAS PKWY STE 213
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1946
Mailing Address - Country:US
Mailing Address - Phone:469-372-2022
Mailing Address - Fax:
Practice Address - Street 1:17060 DALLAS PKWY STE 213
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1946
Practice Address - Country:US
Practice Address - Phone:469-372-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered