Healthcare Provider Details

I. General information

NPI: 1659410686
Provider Name (Legal Business Name): MR. JAMES LEE WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. JAMES LEE WOLFE

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 SE WASHINGTON ST STE 100
HILLSBORO OR
97123-4169
US

IV. Provider business mailing address

678 S FAWN ST
CORNELIUS OR
97113-7019
US

V. Phone/Fax

Practice location:
  • Phone: 971-386-3443
  • Fax: 503-648-0755
Mailing address:
  • Phone: 971-386-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number11-CRM-134
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: