Healthcare Provider Details

I. General information

NPI: 1396325197
Provider Name (Legal Business Name): ROGER I WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 WOODLAWN HTS
CHATHAM VA
24531-3407
US

IV. Provider business mailing address

213 WOODLAWN HTS
CHATHAM VA
24531-3407
US

V. Phone/Fax

Practice location:
  • Phone: 434-429-0360
  • Fax:
Mailing address:
  • Phone: 434-429-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: