1396974366 NPI number — MS. LAQUANYA REMIQUE WILLIAMS OTR

Table of content: MS. LAQUANYA REMIQUE WILLIAMS OTR (NPI 1396974366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396974366 NPI number — MS. LAQUANYA REMIQUE WILLIAMS OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
LAQUANYA
Provider Middle Name:
REMIQUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOWARD
Provider Other First Name:
LAQUANYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396974366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 MCFARLAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHPORT
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35476-2943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-339-5300
Provider Business Mailing Address Fax Number:
205-330-7990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 MCFARLAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35476-2943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-339-5300
Provider Business Practice Location Address Fax Number:
205-330-7990
Provider Enumeration Date:
07/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2532 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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