Healthcare Provider Details

I. General information

NPI: 1306755293
Provider Name (Legal Business Name): QUENTIN SHAHEEM WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 MAYNARD STREET BLDG 305
FORT BRAGG NC
28308
US

IV. Provider business mailing address

383 MAYNARD STREET BLDG 305
FORT BRAGG NC
28308
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-9252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: