Healthcare Provider Details

I. General information

NPI: 1982827390
Provider Name (Legal Business Name): ALLERGY & ASTHMA CLINIC OF GREEN COUNTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SE DEBELL AVE
BARTLESVILLE OK
74006-2305
US

IV. Provider business mailing address

224 SE DEBELL AVE
BARTLESVILLE OK
74006-2305
US

V. Phone/Fax

Practice location:
  • Phone: 918-333-7811
  • Fax: 918-333-4825
Mailing address:
  • Phone: 918-333-7811
  • Fax: 918-333-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number8877
License Number StateOK

VIII. Authorized Official

Name: DR. CURTIS SCOTT WILLIAMS
Title or Position: OWNER
Credential: M.D.
Phone: 918-333-7811