MEDICARE: PAMELA 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	227900000X	Registered Respiratory Therapist	200152	LA

General Provider Information

NPI Number	:	1700093267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA WILLIAMS

Provider Business Mailing Address
First Line	:	3506 JACKSON STREET
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71109-4104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3506 JACKSON STREET
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71109-4104
Country	:	US
Telephone Number	:	318-464-1995
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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