Healthcare Provider Details

I. General information

NPI: 1649026717
Provider Name (Legal Business Name): JOSEPH WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 W MCNICHOLS RD
DETROIT MI
48221-2455
US

IV. Provider business mailing address

18969 LESURE ST
DETROIT MI
48235-1764
US

V. Phone/Fax

Practice location:
  • Phone: 313-341-1821
  • Fax:
Mailing address:
  • Phone: 313-341-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: