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General NPI Number Information
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NPI Number | 1437754967
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Entity Type | Individual
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Provider Name | TOMMY WILLIAMS JR. INC
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Gender | Male
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 1439 BAY RD
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City | WALLACE
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State | NC
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Zip | 28466-9530
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Country | US
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Telephone | 910-441-5415
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Fax |
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Provider Business Mailing Address
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Address Line | 1439 BAY RD
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City | WALLACE
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State | NC
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Zip | 28466-9530
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Country | US
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Telephone | 910-441-5415
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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 | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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