Healthcare Provider Details

I. General information

NPI: 1275139800
Provider Name (Legal Business Name): MELISSA C WILLIAMS CPT, CET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11832 NEWCASTLE AVE STE 17
BATON ROUGE LA
70816-8987
US

IV. Provider business mailing address

11832 NEWCASTLE AVE STE 17
BATON ROUGE LA
70816-8987
US

V. Phone/Fax

Practice location:
  • Phone: 225-389-5020
  • Fax:
Mailing address:
  • Phone: 225-389-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: