Healthcare Provider Details

I. General information

NPI: 1619700010
Provider Name (Legal Business Name): MR. GERALD DARNELL WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 ROSLYN AVE
AKRON OH
44320-3428
US

IV. Provider business mailing address

1405 ROSLYN AVE
AKRON OH
44320-3428
US

V. Phone/Fax

Practice location:
  • Phone: 330-696-2655
  • Fax: 234-678-8151
Mailing address:
  • Phone: 330-696-2655
  • Fax: 234-678-8151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: