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General NPI Number Information
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NPI Number | 1225333073
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Entity Type | Organization
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Legal Business Name | LAKESHORE FAMILY MEDICINE ASSOCIATES, APMC
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 516 LINCOLN RD
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City | MONROE
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State | LA
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Zip | 71203-4252
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Country | US
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Telephone | 318-343-6487
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Fax | 318-343-7884
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Provider Business Mailing Address
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Address Line | PO BOX 13430
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City | MONROE
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State | LA
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Zip | 71213-3430
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Country | US
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Telephone | 318-343-6487
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Fax | 318-343-7884
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. THOMAS ST. CLAIR WILLIAMS SR.
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Credential | M. D.
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Telephone | 318-343-6487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 022964
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License Number State | LA
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