MEDICARE: MR. ANTONEYO WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		TX

General Provider Information

NPI Number	:	1396232997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTONEYO WILLIAMS

Provider Business Mailing Address
First Line	:	830 SHAVER ST APT 204
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77506-3443
Country	:	US
Telephone Number	:	205-246-9678
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 SHAVER ST APT 204
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77506-3443
Country	:	US
Telephone Number	:	205-246-9678
Fax Number	:	205-246-9678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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Directions to “ MR. ANTONEYO WILLIAMS ” Practice Location

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