MEDICARE: ROY LEE WILLIAMS III

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	3747A0650X	Attendant Care Provider		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1790324853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY LEE WILLIAMS III

Provider Business Mailing Address
First Line	:	4482 DAVIS ST
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-2545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4482 DAVIS ST
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-2545
Country	:	US
Telephone Number	:	650-461-0161
Fax Number	:

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

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	01/06/2020

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