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General NPI Number Information
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NPI Number | 1003176447
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Entity Type | Individual
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Provider Name | MR. CHARLES WENDELL WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 6902 MANOR TERRACE LN
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City | RICHMOND
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State | TX
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Zip | 77469-4102
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Country | US
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Telephone | 832-449-3271
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Fax | 832-449-3271
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Provider Business Mailing Address
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Address Line | 6902 MANOR TERRACE LN
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City | RICHMOND
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State | TX
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Zip | 77469-4102
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Country | US
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Telephone | 832-449-3217
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Fax | 832-449-3217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 372600000X
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License Number State | TX
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