Healthcare Provider Details

I. General information

NPI: 1003176447
Provider Name (Legal Business Name): MR. CHARLES WENDELL WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 MANOR TERRACE LN
RICHMOND TX
77469-4102
US

IV. Provider business mailing address

6902 MANOR TERRACE LN
RICHMOND TX
77469-4102
US

V. Phone/Fax

Practice location:
  • Phone: 832-449-3271
  • Fax: 832-449-3271
Mailing address:
  • Phone: 832-449-3217
  • Fax: 832-449-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number372600000X
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: