MEDICARE: RICKEY 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	172A00000X	Driver

General Provider Information

NPI Number	:	1831615228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKEY WILLIAMS

Provider Business Mailing Address
First Line	:	113 BEAUREGARD AVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23075-1113
Country	:	US
Telephone Number	:	804-651-4698
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 BEAUREGARD AVE
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23075-1113
Country	:	US
Telephone Number	:	804-651-4698
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	07/21/2022

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Directions to “ RICKEY WILLIAMS ” Practice Location

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