MEDICARE: MR. DEWAYNE 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1659624583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEWAYNE WILLIAMS

Provider Business Mailing Address
First Line	:	5816 SE 144TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165
Country	:	US
Telephone Number	:	918-810-0808
Fax Number	:

Provider Business Practice Location Address
First Line	:	5816 SE 144TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73165
Country	:	US
Telephone Number	:	918-810-0808
Fax Number	:

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

Provider Enumeration Date	:	10/16/2012
Last Update Date	:	10/16/2012

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