Healthcare Provider Details

I. General information

NPI: 1366290470
Provider Name (Legal Business Name): QUINTAVIA B WILLIAMS MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 W 8 MILE RD # 140
SOUTHFIELD MI
48075-4338
US

IV. Provider business mailing address

1333 E MILTON AVE
HAZEL PARK MI
48030-2388
US

V. Phone/Fax

Practice location:
  • Phone: 800-990-1092
  • Fax:
Mailing address:
  • Phone: 248-910-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: