MEDICARE: ANDRE 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	171WH0202X	Home Modifications Contractor	CGC1515496	FL

General Provider Information

NPI Number	:	1851600530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE WILLIAMS

Provider Business Mailing Address
First Line	:	6137 POST OAK RD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1554
Country	:	US
Telephone Number	:	904-705-6811
Fax Number	:

Provider Business Practice Location Address
First Line	:	6137 POST OAK RD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1554
Country	:	US
Telephone Number	:	904-705-6811
Fax Number	:

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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Directions to “ ANDRE WILLIAMS ” Practice Location

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