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General NPI Number Information
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NPI Number | 1720480080
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Entity Type | Organization
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Legal Business Name | EAST LAWTON NEIGHBORHOOD FAMILY CLINIC, PLLC
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 1102 SE 36TH ST STE. B
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City | LAWTON
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State | OK
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Zip | 73501-8462
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Country | US
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Telephone | 580-280-4644
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Fax | 580-280-4646
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Provider Business Mailing Address
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Address Line | 1102 SE 36TH ST STE. B
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City | LAWTON
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State | OK
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Zip | 73501-8462
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Country | US
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Telephone | 580-280-4644
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Fax | 580-280-4646
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. FRANK RUSSEL WILLIAMS SR.
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Credential | PA-C
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Telephone | 580-280-4644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PA674
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License Number State | OK
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