MEDICARE: DARNELL A WILLIAMS III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	73554462	OH
2	253Z00000X	In Home Supportive Care Agency	73554462	OH
3	3747P1801X	Personal Care Attendant	73554462	OH
4	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	73554462	OH
5	376J00000X	Homemaker	73554462	OH

General Provider Information

NPI Number	:	1194594275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARNELL A WILLIAMS III

Provider Business Mailing Address
First Line	:	1259 HOMEWOOD AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2154
Country	:	US
Telephone Number	:	234-804-2160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1259 HOMEWOOD AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2154
Country	:	US
Telephone Number	:	234-804-2160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2023
Last Update Date	:	12/29/2023

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Directions to “ DARNELL A WILLIAMS III ” Practice Location

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