Healthcare Provider Details

I. General information

NPI: 1780441410
Provider Name (Legal Business Name): ASHLEY LAJUAN WILLIAMS MEDICAL WIG SPECIALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E MARTIN PL
PINE BLUFF AR
71603
US

IV. Provider business mailing address

127 E MARTIN PL
PINE BLUFF AR
71603
US

V. Phone/Fax

Practice location:
  • Phone: 870-329-0622
  • Fax:
Mailing address:
  • Phone: 870-329-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: