Healthcare Provider Details

I. General information

NPI: 1619773280
Provider Name (Legal Business Name): DWAN WILLIAMS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 CANAL ST
NEW ORLEANS LA
70119-5996
US

IV. Provider business mailing address

1441 LAKE AVE APT 201
METAIRIE LA
70005-1857
US

V. Phone/Fax

Practice location:
  • Phone: 504-252-9182
  • Fax:
Mailing address:
  • Phone: 504-495-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: