Healthcare Provider Details

I. General information

NPI: 1902141054
Provider Name (Legal Business Name): MS. LATONIA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JUNCTION CITY RD
EL DORADO AR
71730-7502
US

IV. Provider business mailing address

1514 JUNCTION CITY HIGHWAY
ELDORADO AR
71730
US

V. Phone/Fax

Practice location:
  • Phone: 870-639-3935
  • Fax:
Mailing address:
  • Phone: 870-639-3936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: