Healthcare Provider Details

I. General information

NPI: 1629245022
Provider Name (Legal Business Name): CASEY WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 LESSEP STREET
NEW ORLEANS LA
70117
US

IV. Provider business mailing address

P.O. BOX 4148
NEW ORLEANS LA
70178-4148
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-6041
  • Fax:
Mailing address:
  • Phone: 504-941-6041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPGY.1.EJEFF-FP
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: