MEDICARE: LISA WILLIAMS

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	315P00000X	Intellectual Disabilities Intermediate Care Facility		LA

General Provider Information

NPI Number	:	1427613371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WILLIAMS

Provider Business Mailing Address
First Line	:	8900 TILFORD RD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-2930
Country	:	US
Telephone Number	:	504-319-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 ST. MAURICE AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-7011
Country	:	US
Telephone Number	:	504-319-7792
Fax Number	:

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

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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Directions to “ LISA WILLIAMS ” Practice Location

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