Healthcare Provider Details

I. General information

NPI: 1407786502
Provider Name (Legal Business Name): ADDISON GUILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOHN MARSHALL DR
HUNTINGTON WV
25755-0003
US

IV. Provider business mailing address

1416 7TH AVE APT 6
HUNTINGTON WV
25701-2978
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-2772
  • Fax:
Mailing address:
  • Phone: 740-961-9362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMA
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: