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General NPI Number Information
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NPI Number | 1114712114
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Entity Type | Individual
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Provider Name | DEJUAN C WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 43800 GARFIELD RD STE 200
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1136
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Country | US
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Telephone | 833-202-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 19115 SURREY LN
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City | NORTHVILLE
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State | MI
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Zip | 48167-3136
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Country | US
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Telephone | 313-518-4613
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Fax |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | MI
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